Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom.
Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
Mol Cancer Ther. 2018 Aug;17(8):1670-1682. doi: 10.1158/1535-7163.MCT-18-0010. Epub 2018 Jun 11.
Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest cancers, and overall survival rates have barely improved over the past five decades. The antimetabolite gemcitabine remains part of the standard of care but shows very limited antitumor efficacy. Ataxia telangiectasia and Rad3-related protein (ATR), the apical kinase of the intra-S-phase DNA damage response, plays a central role in safeguarding cells from replication stress and can therefore limit the efficacy of antimetabolite drug therapies. We investigated the ability of the ATR inhibitor, AZD6738, to prevent the gemcitabine-induced intra-S-phase checkpoint activation and evaluated the antitumor potential of this combination and In PDAC cell lines, AZD6738 inhibited gemcitabine-induced Chk1 activation, prevented cell-cycle arrest, and restrained RRM2 accumulation, leading to the strong induction of replication stress markers only with the combination. Moreover, synergistic growth inhibition was identified in a panel of 5 mouse and 7 human PDAC cell lines using both Bliss Independence and Loewe models. In clonogenic assays, the combination abrogated survival at concentrations for which single agents had minor effects. , AZD6738 in combination with gemcitabine was well tolerated and induced tumor regression in a subcutaneous allograft model of a Kras; Trp53; Pdx-Cre (KPC) mouse cancer cell line, significantly extending survival. Remarkably, the combination also induced regression of a subgroup of KPC autochthonous tumors, which generally do not respond well to conventional chemotherapy. Altogether, our data suggest that AZD6738 in combination with gemcitabine merits evaluation in a clinical trial in patients with PDAC. .
胰腺导管腺癌(PDAC)是最致命的癌症之一,在过去的五十年中,总体生存率几乎没有提高。抗代谢药物吉西他滨仍然是标准治疗的一部分,但显示出非常有限的抗肿瘤疗效。共济失调毛细血管扩张症和 Rad3 相关蛋白(ATR)是细胞内 S 期 DNA 损伤反应的顶端激酶,在保护细胞免受复制应激方面起着核心作用,因此可以限制抗代谢药物治疗的疗效。我们研究了 ATR 抑制剂 AZD6738 预防吉西他滨诱导的 S 期内检查点激活的能力,并评估了这种组合的抗肿瘤潜力。在 PDAC 细胞系中,AZD6738 抑制吉西他滨诱导的 Chk1 激活,防止细胞周期停滞,并抑制 RRM2 积累,仅在联合用药时强烈诱导复制应激标志物。此外,使用 Bliss 独立性和 Loewe 模型在 5 种小鼠和 7 种人 PDAC 细胞系的面板中鉴定出协同生长抑制。在集落形成试验中,该组合在单药作用较小的浓度下消除了存活。AZD6738 联合吉西他滨耐受性良好,并在 Kras;Trp53;Pdx-Cre(KPC)小鼠癌细胞系的皮下移植模型中诱导肿瘤消退,显著延长了生存期。值得注意的是,该组合还诱导了一部分 KPC 同源肿瘤的消退,这些肿瘤通常对常规化疗反应不佳。总的来说,我们的数据表明,AZD6738 联合吉西他滨值得在 PDAC 患者的临床试验中进行评估。