Oral - Virtual Presentation 33rd Lorne Cancer Conference 2021

Combining PARP and WEE1 inhibitors in BRCA1/2 wildtype TNBC (#3)

Zhi Ling Teo 1 2 , Mark J O'Connor 3 , Stephanie Versaci 1 , Kylie Clarke 1 , Emmaline Brown 1 , Luke W Percy 1 , Keilly Kuykhoven 1 , Chris P Mintoff 1 , Peter Savas 1 , Balaji Virassamy 1 , Stephen J Luen 1 , Ann Byrne 1 , Sneha Sant 1 , Geoffrey J Lindeman 4 , Phil K Darcy 1 2 , Sherene Loi 1 2
  1. Division of Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville,, VIC, Australia
  3. AstraZeneca Oncology, Cambridge , United Kingdom
  4. Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

Novel therapeutic strategies that can effectively combine with immunotherapies are needed in the treatment of triple-negative breast cancer (TNBC). Here, we show that the PARP inhibitor Olaparib and the WEE1 inhibitor AZD1775 (adavosertib) interact synergistically in BRCA1/2 wildtype TNBC models to induce replication stress and induce effective anti-tumor activity. Given that Olaparib and AZD1775 have overlapping toxicity profiles (1), we have assessed the efficacy of combining lower doses of both olaparib and AZD1775 in this study. The combined treatment induced an anti-tumor inflammatory immune response which increased tumor infiltration and activation of CD4 and CD8 T cells as well as cytotoxic T cell-mediated clearance of tumor cells. Depletion of both T cell subsets abolished the anti-tumor efficacy of combined DDR inhibitor treatment. The addition of anti-PD-1 enhanced the efficacy of PARP and WEE1 inhibition in an immunogenic preclinical model of TNBC but conferred no further benefit to the anti-tumor activity of combined DDR inhibition in poorly immunogenic AT3 and 4T1ch9 models. Combined DDR inhibition with STING agonist resulted in durable tumor regression and significant improvements of survival outcomes in multiple tumor models of TNBC. These findings provide insight into a novel mechanism of action of PARPi and WEE1i in BRCA1/2-wildtype TNBC, and rationale for harnessing the anti-tumor immune responses of DDR inhibitors to potentiate the therapeutic efficacy of immunotherapies to improve patient outcomes.

  1. 1. Pilié PG, Gay CM, Byers LA, Connor MJ, Yap TA. PARP Inhibitors: Extending Benefit Beyond BRCA-Mutant Cancers. Clinical Cancer Research 2019 doi 10.1158/1078-0432.CCR-18-0968.