Abstract B026: Targeting wild type and ESR1 mutations as neoantigens in hormone receptor positive breast cancer
Authors: Gautam Namrata , Albert Gabriella , Synder Colin , Czerniecki Brian 
Published: February 2024

Abstract
Hormone receptor positive (HR+) metastatic breast cancer remains a difficult clinical problem. Endocrine Therapies (ET) have remained the mainstay of therapy for decades. However, a large percent of these patients become resistant to the therapies and succumb to the disease. One of the most common resistance mechanisms is the ER alpha type I (ESR1) point mutations with amino acid substitutions such that they become constitutively active. About 40-50% of metastatic HR+ patients develop these mutations. Hence, there is a need to develop strategies that target WT and mutant ESR1 in order to achieve robust anti-tumor immune responses. Type I polarized dendritic cell (DC1) vaccine developed by our group has shown to be a powerful immunotherapeutic tool to treat breast cancer by boosting the CD4 Th1 responses against oncodrivers like HER2 and HER3. This is facilitated by identification of immunogenic human peptides using a novel peptide screening method targeting these oncodrivers and breaching the tolerance. Having strong evidence of the effectiveness of DC1 vaccines, our study focusses on testing efficacy of DC1 pulsed WT ESR1 peptides (DC1-WT ESR1) and clinically prevalent ESR1 mutations/neoantigens (DC1-Mutant ESR1) in pre-clinical mouse model. In this study, we tested the homology between human and murine WT and mutated ESR1 peptides and also assessed the efficacy of DC1-WT ESR1 and DC1-Mutant ESR1 vaccines in mice to generate CD4 Th1 response (IFNγ production). To develop pre-clinical ESR1 mouse tumor models, two different cell lines were validated for nuclear ESR1 expression. We tested the efficacy of DC1-WT ESR1 vaccine in orthotopic ESR1+ tumor bearing mice by administrating six DC1 vaccines intratumorally. Our results show around 90% and above homology between human and murine WT and mutated ESR1 peptides generating immunogenic responses in mice. In vitro treatment of ESR1+ mouse cell lines with IFNγ resulted in reduced proliferation. This effect was in line with the mouse tumor model, wherein we observed reduced tumor burden post administration of six DC1-WT ESR1 vaccines intratumorally in ESR1+ pre-clinical mouse models. In addition, we observed about a 12% of complete regression in these mice. Upon using combinatorial approaches such as fulvestrant and DC1-WT ESR1, we observed about a 14% of complete regression, however, the DC1 alone mice showed 62% responders and did a lot better than the fulvestrant alone. Overall, these findings suggest that DC1 vaccines targeting ESR1 could be a promising tool to treat aggressive ESR1+ breast cancer. We now aim to use combinatorial approaches such as CDK4/6 inhibitors and DC1-WT ESR1 to boost the anti-tumor responses and further test the efficacy of DC1-Mutant ESR1 vaccines using pre-clinical ESR1+ mouse models.
Citation Format: Namrata Gautam, Gabriella Albert, Colin Synder, Brian Czerniecki. Targeting wild type and ESR1 mutations as neoantigens in hormone receptor positive breast cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B026.