Abstract P4-08-15: Identification of target kinases whose inhibition enhances antitumor efficacy of sacituzumab-govitecan in metastatic HER2-negative breast cancer
Authors: Oh Nakyung , Fuson Jon A. , Liu Huey , Tripathy Debu , Ueno Naoto T. , Lee Jangsoon 
Published: March 2023

Abstract
BACKGROUND HER2-negative (HER2−) breast cancer (BC) subtypes, such as luminal A and triple-negative breast cancer (TNBC), express human trophoblast cell-surface antigen 2 (Trop-2). A high level of Trop-2 expression is associated with a poor prognosis in solid tumors. Sacituzumab-govitecan (SG), a Trop-2–directed antibody conjugated with SN-38 (topoisomerase Ⅰ inhibitor) significantly improves survival in patients with metastatic TNBC. Also, the IMMU-132-01 phase Ⅰ/Ⅱ study revealed that SG has antitumor activity in previously treated hormone receptor (HR)+/HER2− metastatic BC. In a phase Ⅲ trial (TROPiCS-02), SG demonstrated statistically significant progression-free survival in patients with heavily pre-treated HR+/HER2− endocrine-resistant metastatic BC. To augment the efficacy of SG, we sought to identify potential kinase targets whose inhibition enhances the antitumor efficacy of SG to formulate an SG-based combination therapy. MATERIALS AND METHODS Fluorescence-activated cell sorting analysis and Western blotting were used to evaluate the expression of Trop-2 in 24 TNBC and 8 HR+ BC cell lines. Non-biased high-throughput kinome-wide RNAi screening was performed with BT-20 (TNBC) and T47D tamoxifen/abemaciclib double-resistant (HR+) cell lines to identify target kinases whose inhibition produces synergistic antitumor efficacy of SG. To validate the combination antitumor effect of SG and selected kinase target inhibitors, sulforhodamine B staining proliferation assays, cell cycle analysis, and caspase 3/7 activity assays were performed in Trop-2+ TNBC and HR+ BC cell lines, including cell lines resistant to tamoxifen and double-resistant to tamoxifen and CDK4/6 inhibitor (palbociclib or abemaciclib). RESULTS In vitro proliferation assays revealed that the half-maximal inhibitory concentration (IC50) of SG in tested TNBC cell lines ranged from 10 nM to 84 nM, and that of HR+ cell lines ranged from 12.5 nM to &gt;250 nM. We identified 69 kinase targets in TNBC cell line BT-20 and 44 kinase targets in HR+ BC cell line T47D (tamoxifen/abemaciclib double-resistant) by the sensitivity index analysis (&gt;0.15) of RNAi screening results, and further pathway analysis revealed DNA damage response (DDR), (drug: BAY1895344), PI3k/Akt/mTOR (drug: copanlisib), and MAPK (drug: trametinib) as potential target canonical pathways whose targeting enhanced the cytotoxic effect of SG in both TNBC and HR+ BC. Among these strategies, inhibition of the DDR pathway with ATR inhibitor (BAY1895344) yielded a synergistic antiproliferative effect in combination with SG compared to SG or BAY1895344 alone in all tested TNBC and HR+ BC cell lines. Growth inhibition by SG combined with BAY1895344 averaged 97.1% in TNBC cell lines and ranged from 30.7% to 81.3% in HR+ BC cell lines, with P&lt; 0.001. Other combinations with SG showed partially synergistic antiproliferative effects (copanlisib: effective in 3 of 5 cell lines, trametinib: effective in 2 of 5 cell lines). CONCLUSIONS RNAi screening uncovered DDR, PI3k/Akt/mTOR, and MAPK pathways as potential targets for combination with SG. Among inhibitors of these targets, DDR pathway inhibitor BAY1895344 had the most robust synergy with SG, compared to two other target inhibitors, against Trop-2+ TNBC and HR+ BC cell lines. These in vitro data warrant future in vivo validation studies of the synergistic antitumor effect of SG and BAY1895344 in metastatic HER2– breast cancer.
Citation Format: Nakyung Oh, Jon A. Fuson, Huey Liu, Debu Tripathy, Naoto T. Ueno, Jangsoon Lee. Identification of target kinases whose inhibition enhances antitumor efficacy of sacituzumab-govitecan in metastatic HER2-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-08-15.