Targeting androgen receptor signaling in glioblastoma: A novel biomarker and therapeutic approach.
Authors: Mason Sofia , Chung Sylvia , Perez San Juan Beatriz , McCool Cerys , Day Bryan , Zaccaron Milioli Heloisa , Dear Rachel Fitz-Gerald , Sim Hao-Wen , Holst Jeff , Chaffer Christine Louise 
Published: July 2024

e14016 Background: Glioblastoma is a lethal brain cancer. Clinical patterns of disease suggest that androgens influence glioblastoma risk and prognosis, and androgen receptor (AR) transcript levels and protein expression are upregulated in glioblastoma compared to normal brain. Thus, potent brain-penetrant anti-androgen therapies may be an effective treatment strategy in glioblastoma. Methods: Clinical samples and patient-derived glioma xenografts (PDXs) were assessed for AR expression by immunohistochemistry. Glioblastoma cell lines and patient-derived models maintained under stem cell conditions were tested in vitro for their response to anti-androgen therapies (abiraterone, enzalutamide and seviteronel). Change in plasticity marker ZEB1 was measured using immunofluorescence. Stem cell function was assessed using a tumoursphere assay. In an intracranial AR positive glioblastoma PDX model (RN1) in an immunocompromised mouse, the most effective drug in vitro, seviteronel, was tested alone and in combination with temozolomide or radiation. Tumor growth was monitored with weekly bioluminescent imaging, with survival as the primary endpoint. Results: Cytoplasmic AR staining was present in ~55% of glioblastoma samples using immunohistochemistry; this biomarker has shown to be predictive in triple-negative breast cancer. AR positive model RN1 was inhibited by low concentrations of anti-androgen agents, with seviteronel having the lowest half maximal inhibitory concentration (IC50) after 96 h (enzalutamide 52 µM, abiraterone 12 µM, seviteronel 7 µM). AR negative model WK1 was inhibited though with higher IC50 values after 96 h (enzalutamide 63 µM, seviteronel 21 µM). Cell lines U87 and U251 were also inhibited by anti-androgen monotherapy. Immunofluorescence analysis showed downregulation of plasticity marker ZEB1 with anti-androgens (normalized mean fluorescent intensity: abiraterone 0.84, enzalutamide 0.91, seviteronel 0.74). Tumoursphere assays demonstrated that anti-androgens inhibit the tumor-forming ability of cells, with seviteronel and abiraterone showing more inhibition than enzalutamide. In mice intracranially implanted with RN1 cells, seviteronel improved overall survival compared to vehicle alone (36 vs 27.5 days, p=0.03). There was no observed benefit when seviteronel was added to radiotherapy (33 vs 39 days, p=0.19). Adding seviteronel to temozolomide limited tumor growth by IVIS but did not significantly improve overall survival compared to temozolomide alone (63.5 vs 56.5 days, p=0.37). Conclusions: Targeting AR with brain penetrant anti-androgen drugs may be a promising biomarker-directed therapeutic strategy for glioblastoma. To address the limitations of our study, further experiments to optimize translational treatment protocols, address the role of biological sex and examine the role of the immune microenvironment are underway.