Implication of pseudokinase in the response of mTor inhibitors

MTor est une protéine centrale de la voie de signalisation PI3K/AKT/mTor et est impliquée dans la croissance, la prolifération et la survie cellulaire. Cette protéine joue un rôle majeur particulièrement dans la prolifération tumorale. Ainsi des inhibiteurs de mTor ont été développés à partir des années 1980, notamment la rapamycine, et deux sont utilisés actuellement en clinique: l’évérolimus et le temsirolimus. Ces deux inhibiteurs font partie des différentes possibilités thérapeutiques dans les cancers du sein et du rein métastatiques. Les patients traités présentent des réponses variées avec des cas de patients très bons répondeurs et des cas de patients résistants d'emblée ou après exposition au traitement. Face à cette notion de résistance, nous avons voulu caractériser les mécanismes d’adaptation de la cellule tumorale après exposition aux anti-mtor. L’analyse de l’expression génomique de huit lignées cellulaires tumorales variées après traitement par la rapamycine a montré une modulation de l’expression de certains gènes dont celle de la pseudokinase TRIB3, diminuée dans toutes les lignées. Cette donnée in vitro est aussi retrouvée chez les patients. En effet après traitement par évérolimus, nous avons pu observer une diminution de l’expression du gène TRIB3 au niveau sanguin. Nous avons donc cherché à comprendre le rôle de cette pseudokinase dans la réponse aux anti-mTor. Nos résultats mettent en évidence, d’une part, que la rapamycine régule l’expression de TRIB3 en agissant sur son promoteur via une interaction avec GCF2. D’autre part, l’hyperexpression de TRIB3 limite les effets anti-tumoraux de la rapamycine dans différentes lignées cellulaires tumorales. Pour étudier plus en détails ce mécanisme, nous avons cherché à déterminer les partenaires de TRIB3. Par des approches de protéomique haut-débit, nous avons mis en évidence un lien avec des protéines impliquées dans l’épissage. Ainsi la rapamycine semble inhiber la machinerie d’épissage via la diminution d’expression de TRIB3. Ce travail relève l’intérêt de TRIB3 dans la réponse aux anti-mTor comme un potentiel biomarqueur et illustre également le mode d’action de la rapamycine.MTor is a central protein of the PI3K/AKT/mTor signaling pathway and is involved in growth, proliferation and cell survival. This protein plays a major role particularly in tumor proliferation. Thus, mTor inhibitors have been developed since the 1980s, including rapamycin, and two are currently used in daily practice: everolimus and temsirolimus. These two inhibitors are part of the different therapeutic possibilities in metastatic breast and kidney cancers. Patients treated present different responses with cases of very good responders and cases of resistant patients either immediately or after exposure to treatment. According to the concept of resistance, we wanted to characterize the mechanisms of adaptation of the tumor cell after exposure to mTor inhibitors. Analysis of the genomic expression of eight variant tumor cell lines after treatment with rapamycin showed a modulation of the expression of different genes including the pseudokinase TRIB3, decreased in all the lines. This in vitro data is also found in patients. Indeed, after treatment with everolimus, we observed a decreased expression of the TRIB3 gene in blood. We therefore sought to understand the role of this pseudokinase in the response to mTor inhibitors. Our results show, that rapamycin regulates the expression of TRIB3 through a GCF2-dependent inhibition of promoter activity. Moreover, TRIB3 overexpression limits the anti-tumor effects of rapamycin in different tumor cell lines. To investigate this mechanism, we sought to identify TRIB3 partners. By high-throughput proteomic approaches, we have demonstrated a link with proteins involved in splicing. Thus, rapamycin appears to inhibit splicing machinery with the decreased expression of TRIB3. This work highlights the interest of TRIB3 in the response to mTor inhibitors as a potential biomarker and investigates also how rapamycin acts on cells

Association of carcinoid tumor and low grade glioma

Abstract Background Lung carcinoid tumor and low grade glioma are two uncommon malignancies. Patients and methods We report the case of 24-year-old man who presented with respiratory disease. Imaging investigations showed a right lung tumor and histological analysis confirmed a typical carcinoid tumor. As part of initial staging, brain MRI revealed an asymptomatic right frontal lesion. First, a right pulmonary lobectomy was performed without adjuvant treatment. In second time, brain tumorectomy was performed. Histological examination confirmed the diagnosis of low grade glioma (LGG). The patient remained in complete remission 2.5 years after the initial diagnosis. Results This is the first case reporting the association between LGG and lung carcinoid tumor, while no association between LGG and a systemic tumor have been published to date. Association of lung carcinoid tumor with other malignant diseases has been reported but remained uncommon. Only minimal data support a potential molecular common origin. Conclusion This exceptional association may be fortuitous. However, their concomitant diagnoses suggest a potential association between both rare diseases. A genetic susceptibility remains possible.</p

Feasibility and first results of digital patient-reported outcomes measures (PROMs) data collection for patients with localized prostate cancer at diagnosis.

International audience12071 Background: Patient-reported outcomes measures (PROMs) allow optimal evaluation of side effects of treatments and their impact on quality of life. In localized prostate cancer, these PROMs are an interesting tool for comparing the impact of different treatments. The objective of our study was to evaluate the feasibility of a PROMs assessment using a digital application and to analyze the functional outcomes at 1, 3 and 6 months for urinary continence and sexuality. Methods: Since May 2019, patients treated for localized prostate cancer in our center, regardless of the treatment choice, have been offered inclusion in a digital prospective program. PROMs questionnaires (EPIC-26, Q50 PR25, EQ- 5D and PRO-CTCAE) were sent via a dedicated digital application, before treatment (T0), at 1 month (M1), 3 months (M3), 6 months (M6) and 1 year. Program adherence was assessed by the proportion of patients who logged in to the app and the proportion of patients who responded to questionnaires. The first results, at T0, M1, M3 and M6, were analyzed for urinary continence and erectile function, and compared according to age, baseline characteristics and treatment strategy. Results: Between May 2019 and December 2020, 324 patients were included in the program. Thirty patients (9.3%) did not log into the app and 29 (8.9%) logged in but did not respond to the PROMs questionnaires sent out. The adherence rate was not related to age or treatment strategy. In the end, 265 patients (81.8%) answered the PROMs questionnaires, including 185 patients treated by surgery, 11 by brachytherapy, 15 by radiotherapy, 24 by radio-hormonotherapy and 30 under active surveillance. Before treatment (T0), 15.8% (42/265) of patients reported having urine leakage (at least once a week) and 41.5% (110/265) having poor or no erections. At M1, M3, and M6, the incontinence rate was 50.8%, 37.8% and 28.7% respectively, and the erectile dysfunction rate was 73.3%, 74.1% and 70.1% respectively. Sexual recovery was strongly associated with baseline erectile function (T0); patients with good sexual function at diagnosis had an erectile dysfunction rate of 53.8% at 1 month (versus 89.9% for patients with pre-existing sexual dysfunction, p < 0.001), and 51.1% at 3 months (versus 84.0%, p < 0.001). Age was not associated with continence or sexuality recovery. Patients treated with surgery had significantly poorer functional outcomes in terms of continence (p < 0.001) and sexuality (p < 0.001) compared to other strategies. Conclusions: The implementation of PROMs using a digital application achieves an adherence rate of over 80%. The incontinence rate decreases rapidly over the 6 months following treatment, while erectile dysfunction rate remains stable over time. Early side effects are more common after surgery, requiring appropriate supportive strategies

Rapalog-mediated repression of Tribbles pseudokinase 3 regulates pre-mRNA splicing

International audienceRapalogs have become standard-of-care in patients with metastatic breast, kidney, and neuroendocrine cancers. Nevertheless, tumor escape occurs after several months in most patients, highlighting the need to understand mechanisms of resistance. Using a panel of cancer cell lines, we show that rapalogs downregulate the putative protein kinase TRIB3 (tribbles pseudokinase 3). Blood samples of a small cohort of patients with cancer treated with rapalogs confirmed downregulation of TRIB3. Downregulation of TRIB3 was mediated by LRRFIP1 independently of mTOR and disrupted its interaction with the spliceosome, where it participated in rapalog-induced deregulation of RNA splicing. Conversely, overexpression of TRIB3 in a panel of cancer cell lines abolished the cytotoxic effects of rapalogs. These findings identify TRIB3 as a key component of the spliceosome, whose repression contributes significantly to the mechanism of resistance to rapalog therapy. SIGNIFICANCE: Independent of mTOR signaling, rapalogs induce cytoxicity by dysregulating spliceosome function via repression of TRIB3, the loss of which may, in the long term, contribute to therapeutic resistance

Corrigendum: Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review

International audience[This corrects the article DOI: 10.3389/fonc.2021.644301.]

Gastrointestinal Metastases From Primary Renal Cell Cancer: A Single Center Review

International audienceIntroduction: Digestive metastases (DMs) from renal cell cancer (RCC) are rare. Over the past decade, the overall survival of metastatic RCC (mRCC) has been improved by tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors. The main objective of this study was to assess the incidence of metastases of the digestive tract in this new field of treatment. The secondary objectives were to evaluate the clinical characteristics, prognosis, treatments used for DMs, and median time between the diagnosis of RCC or mRCC and DMs. Materials and Methods: A retrospective analysis of data collected from all patients with mRCC between 2007 (the time of TKI was a standard of care) and 2019 was carried out at the Paoli-Calmettes Institute (Marseille, France). Computer research software using artificial intelligence (ConSoRe®) was used to identify patients and assess their characteristics. Results: Between January 2007 and December 2019, 11 out of 660 (1.6%) mRCC patients had metastases of the gastrointestinal tract. The median age was 62 years. Of the 11 patients, 81.8% experienced digestive bleeding or anemia. Only 2 patients were asymptomatic. The metastases were mainly duodenal (50%) and gastric (41.6%). The median time from cancer diagnosis and from metastatic disease to gastrointestinal metastasis was 4.3 years (3 months−19.2 years) and 2.25 years (0 days−10.2 years), respectively. Local treatment was performed in 38.5% of cases by endoscopy (60%), surgery (20%) and radiotherapy (40%) with success rates of 33, 100, and 50%, respectively. Etiological treatment was modified following the discovery of DM in 84.6% of the cases. The median survival was 1 year from the diagnosis of DM (13 days−9.4 years). Two patients were still alive 2.9 and 9.4 years after the diagnosis of DM. Conclusion: This is the largest monocentric retrospective analysis of DM in patients with RCC. It seems to be a rare and late event in the course of the disease. Local treatment combined with systemic treatment could improve survival. In the context of prolonged survival with the new based immunotherapy treatments in mRCC, we suggest that unexplained anemia or persistent digestive symptoms could be explored by endoscopy

Safety and quality of life analyses of apalutamide plus active surveillance vs active surveillance alone for low, intermediate risk prostate cancer.

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Abstract PO1-20-06: Phase 2 study of novel HER2-targeting, TLR7/8 immune-stimulating antibody conjugate (ISAC) BDC-1001 +/- pertuzumab in patients with HER2-positive metastatic breast cancer (MBC) previously treated with trastuzumab deruxtecan

Abstract Background: Therapies to effectively manage patients (pts) with metastatic HER2+ breast cancer have significantly improved over the years, but improvement is still needed in both efficacy and tolerability. BDC-1001 is an ISAC consisting of a trastuzumab biosimilar conjugated to a proprietary cell membrane impermeable TLR7/8 agonist via a non-cleavable linker, administered IV every 2 weeks. It is designed to trigger the innate immune system and generate a durable tumor-targeted adaptive immune response. Preclinical studies indicate that HER2-targeted ISACs elicit potent and durable immune-mediated antitumor efficacy, leading to complete tumor regression in a TLR- and Fc receptor-dependent manner [1]. Moreover, preclinical studies with a murine surrogate of BDC-1001 (trastuzumab-T785 ISAC) indicate improved anti-tumor activity with trastuzumab-T785 compared with trastuzumab/pertuzumab. In these preclinical studies, the combination of trastuzumab-T785 and pertuzumab demonstrated significantly enhanced efficacy in multiple HER2-expressing tumor models, including those with lower HER2 expression [1]. The addition of pertuzumab decreased the quantity of ISAC required for anti-tumor activity in the JIMT-1 HER2 IHC2+ model. Moreover, the combination of pertuzumab with the ISAC significantly increased the cytokine and chemokine concentrations in the tumor xenografts, compared with monotherapy or trastuzumab/pertuzumab, indicating enhanced myeloid activation in the tumor. These preclinical studies suggest that this combination may enhance the clinical activity of trastuzumab-based ISACs. The completed part of the BDC-1001 dose escalation trial (NCT04278144) demonstrated safety, PK and pharmacodynamic changes compatible with the ISAC mechanism of action, and a wide range of antitumor activity (incl. cases with breast cancer); resulting in a RP2D of 20 mg/kg q2w [2]. Two trials are underway, including a Phase 2 trial in other HER2+ malignancies, and a randomized Phase 2 trial with BDC-1001 alone and in combination with pertuzumab in patients with HER2-positive MBC previously treated with 2 or more prior anti-HER2 therapies, including trastuzumab deruxtecan. Methods: The Phase 2 multicenter, open-label, randomized study (BBI-20231001) is enrolling up to 66 pts with HER2-positive (ASCO/CAP guidelines 2018) MBC previously treated with 2 or more prior anti-HER2 therapies, including trastuzumab deruxtecan as one of the prior therapies. Pts must be 18 years or older, have measurable disease (RECIST v1.1), and have Eastern Cooperative Oncology Group performance status of 0 or 1. Pts will be administered BDC-1001 20 mg/kg every 2 weeks (IV q2w) and randomized 1:1 to receive BDC-1001 as a single agent or in combination with pertuzumab. The trial has a Simon 2-stage design within each arm. The primary objective is to determine the overall response rate per RECIST v1.1 of BDC-1001 alone and in combination with pertuzumab. Secondary objectives will evaluate safety, additional efficacy parameters, pharmacokinetics, and immunogenicity of BDC-1001 alone and in combination with pertuzumab. Exploratory objectives will include pharmacodynamic biomarkers in tumor tissue (baseline and on-treatment biopsies if feasible) and in peripheral blood to elucidate the mechanism of action and seek to identify biomarkers associated with BDC-1001 biological activity with or without pertuzumab. This study is expected to initiate accrual in 2H 2023. For additional information, please contact Bolt Biotherapeutics at 1-650-665-9295 or [email protected]. References 1. S. Ackerman et. al., Nature Cancer, 2021 2. Li, B.T. et. al. J Clin Oncol, 2023 (abstr 2538) Citation Format: Mark Pegram, Carmen Calfa, Chris Chen, Alfonso Cortes Salgado, Arielle Heeke, Irene Kang, Barbara Pistilli, Paula Pohlmann, Hope Rugo, Cristina Saura, Cecile Vicier, Cecelia I. Pearson, Coya Tapia, Ming Yin, Tai Yu, Michael N. Alonso, Edith A. Perez, Joshua Drago. Phase 2 study of novel HER2-targeting, TLR7/8 immune-stimulating antibody conjugate (ISAC) BDC-1001 +/- pertuzumab in patients with HER2-positive metastatic breast cancer (MBC) previously treated with trastuzumab deruxtecan [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-20-06