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Przystal* JM, Yadavilli* S, Abadi* CC, Yadav VN, Laternser S, Cosentino CC, Waszak SM, Cartaxo R, Biery M, Myers C, Jayasekara S, Olson JM, Filbin MG, Vitanza NA, Cain J, Koschmann# C, Müller# S, Nazarian# J. DIPG-64. INTERNATIONAL PRECLINICAL DRUG DISCOVERY AND BIOMARKER PROGRAM INFORMING AN ADOPTIVE COMBINATORIAL TRIAL FOR DIFFUSE MIDLINE GLIOMAS. Neuro Oncol 2020. [PMCID: PMC7715218 DOI: 10.1093/neuonc/noaa222.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION DMG-ACT (DMG- multi-arm Adaptive and Combinatorial Trial) aims to implement a highly innovative clinical trial design of combinatorial arms for patients with diffuse midline gliomas (DMGs) at all disease stages that is adaptive to pre-clinical data generated in eight collaborating institutions. The goals of the team are to: i) rapidly identify and validate promising drugs for clinical use, and ii) predict biomarkers for promising drugs. METHODS In vitro (n=15) and in vivo (n=8) models of DMGs across seven institutions were used to assess single and combination treatments with ONC201, ONC206, marizomib, panobinostat, Val-083, and TAK228. In vivo pharmacokinetic assays using clinically relevant dosing of ONC201, ONC206, and panobinostat were performed. Predictive biomarkers for ONC201 and ONC206 were identified using extensive molecular assays including CRISPR, RNAseq, ELISA, FACS, and IHC. RESULTS Inhibitory concentrations (IC50) were established and validated across participating sites. In vivo validation of single and combination drug assays confirmed drug efficacy as increased survival for: ONC201 (p=0.01), ONC206 (p=0.01), ONC201+ONC206 (p=0.02), and ONC201+panobinostat (p=0.01). Marizomib showed toxicity in murine/zebrafish PDXs models. Murine pharmacokinetic analysis showed peak brain levels of ONC201 and ONC206 above pre-clinical IC50. Molecular testing and analyses of existing drug screen across 537 cancer cell lines validated mitochondrial stress and ATF4 as the main targets induced by ONC201/6. CONCLUSION Thorough preclinical testing in a multi-site laboratory setting is feasible and identified ONC201 in combination with ONC206 as promising therapeutics for DMGs. Preclinical and correlative-clinical studies are ongoing.
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Affiliation(s)
- Justyna M Przystal*
- Oncology Department, University Children’s Hospital Zurich, Zürich, Switzerland
| | - Sridevi Yadavilli*
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington DC, USA
| | | | | | - Sandra Laternser
- Oncology Department, University Children’s Hospital Zurich, Zürich, Switzerland
| | | | | | - Rodrigo Cartaxo
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Matt Biery
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Carrie Myers
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Samantha Jayasekara
- Developmental and Cancer Biology Centre for Cancer Research Hudson Institute of Medical Research, Melbourne, Australia
| | - James M Olson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mariella G Filbin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Nicholas A Vitanza
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, USA
| | - Jason Cain
- Developmental and Cancer Biology Centre for Cancer Research Hudson Institute of Medical Research, Melbourne, Australia
| | - Carl Koschmann#
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sabine Müller#
- Oncology Department, University Children’s Hospital Zurich, Zürich, Switzerland
- UCSF Department of Neurology, Neurosurgery and Pediatrics, San Francisco, California, USA
| | - Javad Nazarian#
- Oncology Department, University Children’s Hospital Zurich, Zürich, Switzerland
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington DC, USA
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