Identification of novel therapeutic targets for fibrolamellar carcinoma using patient-derived xenografts and direct-from-patient screening

Gadi Lalazar, David Requena, Lavoisier Ramos-Espiritu, Denise Ng, Patrick D. Bhola, Ype P. de Jong, Ruisi Wang, Nicole J. C. Narayan, Bassem Shebl, Solomon Levin, Eleftherios Michailidis, Mohammad Kabbani, Koen O. A. Vercauteren, Arlene M. Hurley, Benjamin A. Farber, William J. Hammond, James A. Saltsman, Ethan M. Weinberg, J. Fraser Glickman, Barbara A. LyonsJessica Ellison, Erik Schadde, Martin Hertl, Jennifer L. Leiting, Mark J. Truty, Rory L. Smoot, Faith Tierney, Tomoaki Kato, Hans-Guido Wendel, Michael P. LaQuaglia, Charles M. Rice, Anthony Letai, Philip Coffino, Michael S. Torbenson, Michael Ortiz, Sanford M. Simon

Research output: Contribution to journalA1: Web of Science-articlepeer-review

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To repurpose therapeutics for fibrolamellar carcinoma (FLC), we developed and validated patient-derived xenografts (PDX) from surgical resections. Most agents used clinically and inhibitors of oncogenes overexpressed in FLC showed little efficacy on PDX. A high-throughput functional drug screen found primary and metastatic FLC were vulnerable to clinically available inhibitors of TOPO1 and HDAC and to napabucasin. Napabucasin's efficacy was mediated through reactive oxygen species and inhibition of translation initiation, and specific inhibition of eIF4A was effective. The sensitivity of each PDX line inversely correlated with expression of the antiapoptotic protein Bcl-xL, and inhibition of Bcl-xL synergized with other drugs. Screening directly on cells dissociated from patient resections validated these results. This demonstrates that a direct functional screen on patient tumors provides therapeutically informative data within a clinically useful time frame. Identifying these novel therapeutic targets and combination therapies is an urgent need, as effective therapeutics for FLC are currently unavailable.

SIGNIFICANCE: Therapeutics informed by genomics have not yielded effective therapies for FLC. A functional screen identified TOPO1, HDAC inhibitors, and napabucasin as efficacious and synergistic with inhibition of Bcl-xL. Validation on cells dissociated directly from patient tumors demonstrates the ability for functional precision medicine in a solid tumor.

Original languageEnglish
JournalCancer Discovery
Issue number10
Pages (from-to)2544-2563
Number of pages20
Publication statusPublished - 2021




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