Abstract 4160: Impact of oral selective estrogen receptor degrader RAD1901 in preclinical models of endocrine sensitive/resistant breast cancer
Authors: Pancholi Sunil , Nikitorowicz-Buniak Joanna , Ribas Ricardo , Simigdala Nikiana , Garner Fiona , Bihani Teeru , Johnston Stephen R. , Dowsett Mitch , Martin Lesley-Ann 
Published: July 2017

Abstract
Aromatase inhibitors (AI) are the mainstay for treatment of postmenopausal estrogen receptor positive (ER+) primary breast cancer (BC). However, many patients relapse whilst retaining a functional ER. The selective ER degrader (SERD) fulvestrant has been evaluated as a potential 2nd or 3rd line therapy for patients who relapse on AI treatment. Although exhibiting promising potential, its low bioavailability has limited its use to combination therapy in metastatic patients. Here, we assessed the efficacy of the orally available SERD, RAD1901, in a panel of BC cells with varying genetic backgrounds modelling patients both sensitive and resistant to AI therapy (LTED). Fulvestrant was used in parallel to allow relative responses to be compared. Cell proliferation assays in 2D and spheroids the presence of 0.01nM 17β-estradiol showed a concentration-dependent decrease in proliferation in response to RAD1901 and fulvestrant. GI50 values for RAD1901 in general were 10-fold higher than fulvestrant but equated to doses that are clinically achievable for RAD1901. Most importantly, RAD1901 effectively suppressed proliferation of two LTED models harbouring naturally occurring ESR1 mutations, MCF7 LTEDY537C (GI50 5nM) and SUM44-LTEDY537S (GI50 100nM). GI50 values of RAD1901 and fulvestrant showed similar reduction of ER, progesterone receptor (PGR) and cyclin D1 together with decreased phosphorylation of retinoblastoma (RB), concordant with cell cycle arrest. Furthermore, chromatin immunoprecipitation (ChIP) for ER in response to RAD1901 or fulvestrant showed a 70% reduction in recruitment of ER to TFF1, GREB1 and PGR promoters and concomitant reduction in mRNA expression of these genes. In MCF7-Arom cells, combination of letrozole with RAD1901 or fulvestrant showed enhanced antiproliferative effect compared to letrozole alone. The addition of RAD1901 to CDK4/6 inhibitor palbociclib or abemaciclib demonstrated additivity compared with monotherapy. In addition, RAD1901 effectively inhibited growth of palbociclib-resistant MCF7 LTED cells.These preclinical findings highlight the potential utility of RAD1901 as a potent drug in the treatment of ER+ BC. Combined with its bioavailability profile, RAD1901 warrants clinical testing versus fulvestrant after relapse on an AI, either alone or in combination with a CDK4/6 inhibitor.
Citation Format: Sunil Pancholi, Joanna Nikitorowicz-Buniak, Ricardo Ribas, Nikiana Simigdala, Fiona Garner, Teeru Bihani, Stephen R. Johnston, Mitch Dowsett, Lesley-Ann Martin. Impact of oral selective estrogen receptor degrader RAD1901 in preclinical models of endocrine sensitive/resistant breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4160. doi:10.1158/1538-7445.AM2017-4160