bims-tucedo 2021-09-12 papers

bims-tucedo

Biomed News

on Tumor cell dormancy

Issue of 2021‒09‒12
27 papers selected by
Isabel Puig Borreil
Vall d’Hebron Institute of Oncology

Restoring order at the cell cycle border: Co-targeting CDK4/6 and CDK2.
Cell plasticity, senescence, and quiescence in cancer stem cells: Biological and therapeutic implications.
Inhibition of CK1ε potentiates the therapeutic efficacy of CDK4/6 inhibitor in breast cancer.
Single-cell ATAC and RNA sequencing reveal pre-existing and persistent cells associated with prostate cancer relapse.
An androgen receptor switch underlies lineage infidelity in treatment-resistant prostate cancer.
Better together: circulating tumor cell clustering in metastatic cancer.
HRAS is a therapeutic target in malignant chemo-resistant adenomyoepithelioma of the breast.
Allosteric inhibition of HER2 by Moesin-mimicking compounds targets HER2-positive cancers and brain metastases.
Novel nanomedicines to overcome cancer multidrug resistance.
TGF-β/Activin Signaling Promotes CDK7 Inhibitor Resistance in Triple Negative Breast Cancer Cells through Upregulation of Multidrug Transporters.
Mammary-specific expression of Trim24 establishes a mouse model of human metaplastic breast cancer.
Circulating Tumor DNA Dynamics Predict Benefit from Consolidation Immunotherapy in Locally Advanced Non-Small Cell Lung Cancer.
Transcriptional network involving ERG and AR orchestrates Distal-less homeobox-1 mediated prostate cancer progression.
A combination of PARP and CHK1 inhibitors efficiently antagonizes MYCN-driven tumors.
Clinical definition of acquired resistance to immunotherapy in patients with metastatic non-small cell lung cancer.
Beyond Chemotherapy and Checkpoint Inhibitors: Weighing the Risks and Benefits of the Novel Therapies for Metastatic Urothelial Carcinoma.
Single-cell exome sequencing reveals multiple subclones in metastatic colorectal carcinoma.
Genomic temporal heterogeneity of circulating tumour DNA in unresectable metastatic colorectal cancer under first-line treatment.
Tumor-initiating stem cell shapes its microenvironment into an immunosuppressive barrier and pro-tumorigenic niche.
Clinical and therapeutic relevance of cancer-associated fibroblasts.
EZH2 accompanies prostate cancer progression.
Drug resistance in colorectal cancer: An epigenetic overview.
Molecular features of exceptional response to neoadjuvant anti-androgen therapy in high-risk localized prostate cancer.
Feasibility and first reports of the MATCH-R repeated biopsy trial at Gustave Roussy.
Using DNA sequencing data to quantify T cell fraction and therapy response.
Genomic and evolutionary classification of lung cancer in never smokers.
FOXK2 transcriptionally activating VEGFA induces apatinib resistance in anaplastic thyroid cancer through VEGFA/VEGFR1 pathway.

Cancer Cell. 2021 Aug 21. pii: S1535-6108(21)00447-5. [Epub ahead of print]

Restoring order at the cell cycle border: Co-targeting CDK4/6 and CDK2.

Rinath Jeselsohn, Rachel Schiff, Albert Grinshpun.

Overcoming resistance to CDK4/6 inhibitors is a major clinical challenge. In this issue of Cancer Cell, Freeman-Cook et al. study mechanisms of resistance to CDK4/6 inhibitors by employing a CRISPRa screen. They identify the cyclin E-CDK2 axis and Myc signaling as key pathways of resistance and develop PF-06873600, a selective CDK2/4/6 inhibitor.

DOI: https://doi.org/10.1016/j.ccell.2021.08.007
Pharmacol Ther. 2021 Sep 01. pii: S0163-7258(21)00187-X. [Epub ahead of print] 107985

Cell plasticity, senescence, and quiescence in cancer stem cells: Biological and therapeutic implications.

Ritama Paul, Jay F Dorsey, Yi Fan.

  Cancer stem cells (CSCs) are a distinct population of cells within tumors with capabilities of self-renewal and tumorigenicity. CSCs play a privotal role in cancer progression, metastasis, and relapse and tumor resistance to cytotoxic therapy. Emerging scientific evidence indicates that CSCs adopt several mechanisms, driven by cellular plasticity, senescence and quiescence, to maintain their self-renewal capability and to resist tumor microenvironmental stress and treatments. This poses major hindrances for CSC-targeting anti-cancer therapies: cell plasticity maintains stemness in CSCs and renders tumor cells to acquire stem-like phenotypes, contributing to tumor heterogeneity and CSC generation; cellular senescence induces genetic reprogramming and stemness activation, leading to CSC-mediated tumor progression and metastasis; cell quienscence facilitates CSC to overcome their intrinsic vulnerabilities and therapeutic stress, inducing tumor relapse and therapy resistance. These mechanisms are subjected to spatiotemporal regulation by hypoxia, CSC niche, and extracellular matrix in the tumor microenvironment. Here we integrate the recent advances and current knowledge to elucidate the mechanisms involved in the regulation of plasticity, senescence and quiescence of CSCs and the potential therapeutic implications for the future.

Keywords:  Cancer stem cells; Plasticity; Quiescence; Senescence; Therapy resistance; Tumor microenvironment

DOI:  https://doi.org/10.1016/j.pharmthera.2021.107985
Nat Commun. 2021 Sep 10. 12(1): 5386

Inhibition of CK1ε potentiates the therapeutic efficacy of CDK4/6 inhibitor in breast cancer.

Fabin Dang, Li Nie, Jin Zhou, Kouhei Shimizu, Chen Chu, Zhong Wu, Anne Fassl, Shizhong Ke, Yuangao Wang, Jinfang Zhang, Tao Zhang, Zhenbo Tu, Hiroyuki Inuzuka, Piotr Sicinski, Adam J Bass, Wenyi Wei.

Although inhibitors targeting CDK4/6 kinases (CDK4/6i) have shown promising clinical prospect in treating ER+/HER2- breast cancers, acquired drug resistance is frequently observed and mechanistic knowledge is needed to harness their full clinical potential. Here, we report that inhibition of CDK4/6 promotes βTrCP1-mediated ubiquitination and proteasomal degradation of RB1, and facilitates SP1-mediated CDK6 transcriptional activation. Intriguingly, suppression of CK1ε not only efficiently prevents RB1 from degradation, but also prevents CDK4/6i-induced CDK6 upregulation by modulating SP1 protein stability, thereby enhancing CDK4/6i efficacy and overcoming resistance to CDK4/6i in vitro. Using xenograft and PDX models, we further demonstrate that combined inhibition of CK1ε and CDK4/6 results in marked suppression of tumor growth in vivo. Altogether, these results uncover the molecular mechanisms by which CDK4/6i treatment alters RB1 and CDK6 protein abundance, thereby driving the acquisition of CDK4/6i resistance. Importantly, we identify CK1ε as an effective target for potentiating the therapeutic efficacy of CDK4/6 inhibitors.

DOI: https://doi.org/10.1038/s41467-021-25700-6
Nat Commun. 2021 Sep 06. 12(1): 5307

Single-cell ATAC and RNA sequencing reveal pre-existing and persistent cells associated with prostate cancer relapse.

S Taavitsainen, N Engedal, S Cao, F Handle, A Erickson, S Prekovic, D Wetterskog, T Tolonen, E M Vuorinen, A Kiviaho, R Nätkin, T Häkkinen, W Devlies, S Henttinen, R Kaarijärvi, M Lahnalampi, H Kaljunen, K Nowakowska, H Syvälä, M Bläuer, P Cremaschi, F Claessens, T Visakorpi, T L J Tammela, T Murtola, K J Granberg, A D Lamb, K Ketola, I G Mills, G Attard, W Wang, M Nykter, A Urbanucci.

Prostate cancer is heterogeneous and patients would benefit from methods that stratify those who are likely to respond to systemic therapy. Here, we employ single-cell assays for transposase-accessible chromatin (ATAC) and RNA sequencing in models of early treatment response and resistance to enzalutamide. In doing so, we identify pre-existing and treatment-persistent cell subpopulations that possess regenerative potential when subjected to treatment. We find distinct chromatin landscapes associated with enzalutamide treatment and resistance that are linked to alternative transcriptional programs. Transcriptional profiles characteristic of persistent cells are able to stratify the treatment response of patients. Ultimately, we show that defining changes in chromatin and gene expression in single-cell populations from pre-clinical models can reveal as yet unrecognized molecular predictors of treatment response. This suggests that the application of single-cell methods with high analytical resolution in pre-clinical models may powerfully inform clinical decision-making.

DOI: https://doi.org/10.1038/s41467-021-25624-1
Nat Cell Biol. 2021 Sep 06.

An androgen receptor switch underlies lineage infidelity in treatment-resistant prostate cancer.

Alastair Davies, Shaghayegh Nouruzi, Dwaipayan Ganguli, Takeshi Namekawa, Daksh Thaper, Simon Linder, Fatih Karaoğlanoğlu, Meltem E Omur, Soojin Kim, Maxim Kobelev, Sahil Kumar, Olena Sivak, Chiara Bostock, Jennifer Bishop, Marlous Hoogstraat, Amina Talal, Suzan Stelloo, Henk van der Poel, Andries M Bergman, Musaddeque Ahmed, Ladan Fazli, Haojie Huang, Wayne Tilley, David Goodrich, Felix Y Feng, Martin Gleave, Housheng Hansen He, Faraz Hach, Wilbert Zwart, Himisha Beltran, Luke Selth, Amina Zoubeidi.

Cancers adapt to increasingly potent targeted therapies by reprogramming their phenotype. Here we investigated such a phenomenon in prostate cancer, in which tumours can escape epithelial lineage confinement and transition to a high-plasticity state as an adaptive response to potent androgen receptor (AR) antagonism. We found that AR activity can be maintained as tumours adopt alternative lineage identities, with changes in chromatin architecture guiding AR transcriptional rerouting. The epigenetic regulator enhancer of zeste homologue 2 (EZH2) co-occupies the reprogrammed AR cistrome to transcriptionally modulate stem cell and neuronal gene networks-granting privileges associated with both fates. This function of EZH2 was associated with T350 phosphorylation and establishment of a non-canonical polycomb subcomplex. Our study provides mechanistic insights into the plasticity of the lineage-infidelity state governed by AR reprogramming that enabled us to redirect cell fate by modulating EZH2 and AR, highlighting the clinical potential of reversing resistance phenotypes.

DOI: https://doi.org/10.1038/s41556-021-00743-5
Trends Cancer. 2021 Sep 01. pii: S2405-8033(21)00146-1. [Epub ahead of print]

Better together: circulating tumor cell clustering in metastatic cancer.

Emma Schuster, Rokana Taftaf, Carolina Reduzzi, Mary K Albert, Isabel Romero-Calvo, Huiping Liu.

  Circulating tumor cells (CTCs) are vital components of liquid biopsies for diagnosis of residual cancer, monitoring of therapy response, and prognosis of recurrence. Scientific dogma focuses on metastasis mediated by single CTCs, but advancement of CTC detection technologies has elucidated multicellular CTC clusters, which are associated with unfavorable clinical outcomes and a 20- to 100-fold greater metastatic potential than single CTCs. While the mechanistic understanding of CTC cluster formation is still in its infancy, multiple cell adhesion molecules and tight junction proteins have been identified that underlie the outperforming attributes of homotypic and heterotypic CTC clusters, such as cell survival, cancer stemness, and immune evasion. Future directions include high-resolution characterization of CTCs at multiomic levels for diagnostic/prognostic evaluations and targeted therapies.

Keywords:  CTC clusters; breast cancer; circulating tumor cells (CTCs); liquid biopsy

DOI:  https://doi.org/10.1016/j.trecan.2021.07.001
J Hematol Oncol. 2021 Sep 08. 14(1): 143

HRAS is a therapeutic target in malignant chemo-resistant adenomyoepithelioma of the breast.

Ivan Bièche, Florence Coussy, Rania El-Botty, Sophie Vacher, Sophie Château-Joubert, Ahmed Dahmani, Elodie Montaudon, Cécile Reyes, David Gentien, Fabien Reyal, Francesco Ricci, André Nicolas, Caterina Marchio, Anne Vincent-Salomon, Marick Laé, Elisabetta Marangoni.

  Malignant adenomyoepithelioma (AME) of the breast is an exceptionally rare form of breast cancer, with a significant metastatic potential. Chemotherapy has been used in the management of advanced AME patients, however the majority of treatments are not effective. Recent studies report recurrent mutations in the HRAS Q61 hotspot in small series of AMEs, but there are no preclinical or clinical data showing H-Ras protein as a potential therapeutic target in malignant AMEs. We performed targeted sequencing of tumours' samples from new series of 13 AMEs, including 9 benign and 4 malignant forms. Samples from the breast tumour and the matched axillary metastasis of one malignant HRAS mutated AME were engrafted and two patient-derived xenografts (PDX) were established that reproduced the typical AME morphology. The metastasis-derived PDX was treated in vivo by different chemotherapies and a combination of MEK and BRAF inhibitors (trametinib and dabrafenib). All malignant AMEs presented a recurrent mutation in the HRAS G13R or G12S hotspot. Mutation of PIK3CA were found in both benign and malignant AMEs, while AKT1 mutations were restricted to benign AMEs. Treatment of the PDX by the MEK inhibitor trametinib, resulted in a marked anti-tumor activity, in contrast to the BRAF inhibitor and the different chemotherapies that were ineffective. Overall, these findings further expand on the genetic features of AMEs and suggest that patients carrying advanced HRAS-mutated AMEs could potentially be treated with MEK inhibitors.

Keywords:  Adenomyoepithelioma; HRAS; MEK inhibitor; PDX

DOI:  https://doi.org/10.1186/s13045-021-01158-3
Cancer Res. 2021 Sep 07. pii: canres.0162.2021. [Epub ahead of print]

Allosteric inhibition of HER2 by Moesin-mimicking compounds targets HER2-positive cancers and brain metastases.

Camille Faure, Rym Djerbi-Bouillié, Anaïs Domingot, Haniaa Bouzinba-Segard, Saïd Taouji, Yanis Saidi, Sandra Bernard, Floriane Carallis, Romy Rothe-Walther, Jean-Luc Lenormand, Eric Chevet, Sandrine Bourdoulous.

Therapies targeting the tyrosine kinase receptor HER2 have significantly improved survival of HER2+ cancer patients. However, both de novo and acquired resistance remain a challenge, particularly in the brain metastatic setting. Here we report that, unlike other HER tyrosine kinase receptors, HER2 possesses a binding motif in its cytosolic juxtamembrane region that allows interaction with members of the ezrin/radixin/moesin (ERM) family. Under physiological conditions, this interaction controls the localization of HER2 in ERM-enriched domains and stabilizes HER2 in a catalytically repressed state. In HER2+ breast cancers, low expression of moesin correlated with increased HER2 expression. Restoring expression of ERM proteins in HER2+ breast cancer cells was sufficient to revert HER2 activation and inhibit HER2-dependent proliferation. A high-throughput assay recapitulating the HER2/ERM interaction allowed for screening of about 1500 approved drugs. From this screen, Zuclopenthixol, an anti-psychotic drug that behaved as a moesin-mimicking compound, was found to directly bind the juxtamembrane region of HER2 and specifically inhibit HER2 activation in HER2+ cancers, as well as activation of oncogenic mutated and truncated forms of HER2. Zuclopenthixol efficiently inhibited HER2-positive breast tumor progression in vitro and in vivo and, more importantly, showed significant activity on HER2-positive brain tumor progression. Collectively, these data reveal a novel class of allosteric HER2 inhibitors, increasing the number of approaches to consider for intervention on HER2+ breast cancers and brain metastases.

DOI: https://doi.org/10.1158/0008-5472.CAN-21-0162
Drug Resist Updat. 2021 Aug 04. pii: S1368-7646(21)00035-2. [Epub ahead of print]58 100777

Novel nanomedicines to overcome cancer multidrug resistance.

Zhenwei Su, Shaowei Dong, Shan-Chao Zhao, Kaisheng Liu, Yao Tan, Xingyu Jiang, Yehuda G Assaraf, Bo Qin, Zhe-Sheng Chen, Chang Zou.

  Chemotherapy remains a powerful tool to eliminate malignant cells. However, the efficacy of chemotherapy is compromised by the frequent emergence of intrinsic and acquired multidrug resistance (MDR). These chemoresistance modalities are based on a multiplicity of molecular mechanisms of drug resistance, including : 1) Impaired drug uptake into cancer cells; 2) Increased expression of ATP-binding cassette efflux transporters; 3) Loss of function of pro-apoptotic factors; 4) Enhanced DNA repair capacity; 5) Qualitative or quantitative alterations of specific cellular targets; 6) Alterations that allow cancer cells to tolerate adverse or stressful conditions; 7) Increased biotransformation or metabolism of anticancer drugs to less active or completely inactive metabolites; and 8) Intracellular and intercellular drug sequestration in well-defined organelles away from the cellular target. Hence, one of the major aims of cancer research is to develop novel strategies to overcome cancer drug resistance. Over the last decades, nanomedicine, which focuses on targeted delivery of therapeutic drugs into tumor tissues using nano-sized formulations, has emerged as a promising tool for cancer treatment. Therefore, nanomedicine has been introduced as a reliable approach to improve treatment efficacy and minimize detrimental adverse effects as well as overcome cancer drug resistance. With rationally designed strategies including passively targeted delivery, actively targeted delivery, delivery of multidrug combinations, as well as multimodal combination therapy, nanomedicine paves the way towards efficacious cancer treatment and hold great promise in overcoming cancer drug resistance. Herein, we review the recent progress of nanomaterials used in medicine, including liposomal nanoparticles, polymeric nanoparticles, inorganic nanoparticles and hybrid nanoparticles, to surmount cancer multidrug resistance. Finally, the future perspectives of the application of nanomedicine to reverse cancer drug resistance will be addressed.

Keywords:  Antitumor drugs; Cancer; Drug resistance; MDR; Nanomedicine; P-gp/ABCB1

DOI:  https://doi.org/10.1016/j.drup.2021.100777
J Biol Chem. 2021 Sep 02. pii: S0021-9258(21)00964-9. [Epub ahead of print] 101162

TGF-β/Activin Signaling Promotes CDK7 Inhibitor Resistance in Triple Negative Breast Cancer Cells through Upregulation of Multidrug Transporters.

Bryan M Webb, Benjamin L Bryson, Eduardo Williams-Medina, Jessica R Bobbitt, Darcie D Seachrist, Lindsey J Anstine, Ruth A Keri.

  Cyclin dependent kinase 7 (CDK7) is a master regulatory kinase that drives cell cycle progression and stimulates expression of oncogenes in a myriad of cancers. Inhibitors of CDK7 (CDK7i) are currently in clinical trials; however, as with many cancer therapies, patients will most likely experience recurrent disease due to acquired resistance. Identifying targets underlying CDK7i resistance will facilitate prospective development of new therapies that can circumvent such resistance. Here we utilized triple negative breast cancer (TNBC) as a model to discern mechanisms of resistance as it has been previously shown to be highly responsive to CDK7 inhibitors. After generating cell lines with acquired resistance, high throughput RNA-sequencing revealed significant upregulation of genes associated with efflux pumps and transforming growth factor-beta (TGF-β) signaling pathways. Genetic silencing or pharmacological inhibition of ABCG2, an efflux pump associated with multi-drug resistance, re-sensitized resistant cells to CDK7i, indicating a reliance on these transporters. Expression of activin A (INHBA), a member of the TGF-β family of ligands, was also induced, while its intrinsic inhibitor, follistatin (FST), was repressed. In resistant cells, increased phosphorylation of SMAD3, a downstream mediator, confirmed an increase in activin signaling, and phosphorylated SMAD3 directly bound the ABCG2 promoter regulatory region. Lastly, pharmacological inhibition of TGF-β/activin receptors or genetic silencing of SMAD4, a transcriptional partner of SMAD3, reversed the upregulation of ABCG2 in resistant cells and phenocopied ABCG2 inhibition. This study reveals that inhibiting the TGF-β/Activin-ABCG2 pathway is a potential avenue for preventing or overcoming resistance to CDK7 inhibitors.

Keywords:  ABCG2; CDK7; SY-1365; TGF-β; THZ1; TNBC; activin; cyclin dependent kinase 7; multidrug transporters; triple negative breast cancer

DOI:  https://doi.org/10.1016/j.jbc.2021.101162
Nat Commun. 2021 Sep 10. 12(1): 5389

Mammary-specific expression of Trim24 establishes a mouse model of human metaplastic breast cancer.

Vrutant V Shah, Aundrietta D Duncan, Shiming Jiang, Sabrina A Stratton, Kendra L Allton, Clinton Yam, Abhinav Jain, Patrick M Krause, Yue Lu, Shirong Cai, Yizheng Tu, Xinhui Zhou, Xiaomei Zhang, Yan Jiang, Christopher L Carroll, Zhijun Kang, Bin Liu, Jianjun Shen, Mihai Gagea, Sebastian M Manu, Lei Huo, Michael Gilcrease, Reid T Powell, Lei Guo, Clifford Stephan, Peter J Davies, Jan Parker-Thornburg, Guillermina Lozano, Richard R Behringer, Helen Piwnica-Worms, Jeffrey T Chang, Stacy L Moulder, Michelle Craig Barton.

Conditional overexpression of histone reader Tripartite motif containing protein 24 (TRIM24) in mouse mammary epithelia (Trim24COE) drives spontaneous development of mammary carcinosarcoma tumors, lacking ER, PR and HER2. Human carcinosarcomas or metaplastic breast cancers (MpBC) are a rare, chemorefractory subclass of triple-negative breast cancers (TNBC). Comparison of Trim24COE metaplastic carcinosarcoma morphology, TRIM24 protein levels and a derived Trim24COE gene signature reveals strong correlation with human MpBC tumors and MpBC patient-derived xenograft (PDX) models. Global and single-cell tumor profiling reveal Met as a direct oncogenic target of TRIM24, leading to aberrant PI3K/mTOR activation. Here, we find that pharmacological inhibition of these pathways in primary Trim24COE tumor cells and TRIM24-PROTAC treatment of MpBC TNBC PDX tumorspheres decreased cellular viability, suggesting potential in therapeutically targeting TRIM24 and its regulated pathways in TRIM24-expressing TNBC.

DOI: https://doi.org/10.1038/s41467-021-25650-z
Nat Cancer. 2020 Feb;1(2): 176-183

Circulating Tumor DNA Dynamics Predict Benefit from Consolidation Immunotherapy in Locally Advanced Non-Small Cell Lung Cancer.

Everett J Moding, Yufei Liu, Barzin Y Nabet, Jacob J Chabon, Aadel A Chaudhuri, Angela B Hui, Rene F Bonilla, Ryan B Ko, Christopher H Yoo, Linda Gojenola, Carol D Jones, Jianzhong He, Yawei Qiao, Ting Xu, John V Heymach, Anne Tsao, Zhongxing Liao, Daniel R Gomez, Millie Das, Sukhmani K Padda, Kavitha J Ramchandran, Joel W Neal, Heather A Wakelee, Billy W Loo, Steven H Lin, Ash A Alizadeh, Maximilian Diehn.

Circulating tumor DNA (ctDNA) molecular residual disease (MRD) following curative-intent treatment strongly predicts recurrence in multiple tumor types, but whether further treatment can improve outcomes in patients with MRD remains unclear. We applied CAPP-Seq ctDNA analysis to 218 samples from 65 patients receiving chemoradiation therapy (CRT) for locally advanced NSCLC, including 28 patients receiving consolidation immune checkpoint inhibition (CICI). Patients with undetectable ctDNA after CRT had excellent outcomes whether or not they received CICI. Among such patients, one died from CICI-related pneumonitis, highlighting the potential utility of only treating patients with MRD. In contrast, patients with MRD after CRT who received CICI had significantly better outcomes than patients who did not receive CICI. Furthermore, the ctDNA response pattern early during CICI identified patients responding to consolidation therapy. Our results suggest that CICI improves outcomes for NSCLC patients with MRD and that ctDNA analysis may facilitate personalization of consolidation therapy.

DOI: https://doi.org/10.1038/s43018-019-0011-0
Nat Commun. 2021 Sep 07. 12(1): 5325

Transcriptional network involving ERG and AR orchestrates Distal-less homeobox-1 mediated prostate cancer progression.

Sakshi Goel, Vipul Bhatia, Sushmita Kundu, Tanay Biswas, Shannon Carskadon, Nilesh Gupta, Mohammad Asim, Colm Morrissey, Nallasivam Palanisamy, Bushra Ateeq.

Distal-less homeobox-1 (DLX1) is a well-established non-invasive biomarker for prostate cancer (PCa) diagnosis, however, its mechanistic underpinnings in disease pathobiology are not known. Here, we reveal the oncogenic role of DLX1 and show that abrogating its function leads to reduced tumorigenesis and metastases. We observed that ~60% of advanced-stage and metastatic patients display higher DLX1 levels. Moreover, ~96% of TMPRSS2-ERG fusion-positive and ~70% of androgen receptor (AR)-positive patients show elevated DLX1, associated with aggressive disease and poor survival. Mechanistically, ERG coordinates with enhancer-bound AR and FOXA1 to drive transcriptional upregulation of DLX1 in ERG-positive background. However, in ERG-negative context, AR/AR-V7 and FOXA1 suffice to upregulate DLX1. Notably, inhibiting ERG/AR-mediated DLX1 transcription using BET inhibitor (BETi) or/and anti-androgen drugs reduce its expression and downstream oncogenic effects. Conclusively, this study establishes DLX1 as a direct-target of ERG/AR with an oncogenic role and demonstrates the clinical significance of BETi and anti-androgens for DLX1-positive patients.

DOI: https://doi.org/10.1038/s41467-021-25623-2
Oncogene. 2021 Sep 10.

A combination of PARP and CHK1 inhibitors efficiently antagonizes MYCN-driven tumors.

Stefano Di Giulio, Valeria Colicchia, Fabio Pastorino, Flaminia Pedretti, Francesca Fabretti, Vittoria Nicolis di Robilant, Valentina Ramponi, Giorgia Scafetta, Marta Moretti, Valerio Licursi, Francesca Belardinilli, Giovanna Peruzzi, Paola Infante, Bianca Maria Goffredo, Anna Coppa, Gianluca Canettieri, Armando Bartolazzi, Mirco Ponzoni, Giuseppe Giannini, Marialaura Petroni.

MYCN drives aggressive behavior and refractoriness to chemotherapy, in several tumors. Since MYCN inactivation in clinical settings is not achievable, alternative vulnerabilities of MYCN-driven tumors need to be explored to identify more effective and less toxic therapies. We previously demonstrated that PARP inhibitors enhance MYCN-induced replication stress and promote mitotic catastrophe, counteracted by CHK1. Here, we showed that PARP and CHK1 inhibitors synergized to induce death in neuroblastoma cells and in primary cultures of SHH-dependent medulloblastoma, their combination being more effective in MYCN amplified and MYCN overexpressing cells compared to MYCN non-amplified cells. Although the MYCN amplified IMR-32 cell line carrying the p.Val2716Ala ATM mutation showed the highest sensitivity to the drug combination, this was not related to ATM status, as indicated by CRISPR/Cas9-based correction of the mutation. Suboptimal doses of the CHK1 inhibitor MK-8776 plus the PARP inhibitor olaparib led to a MYCN-dependent accumulation of DNA damage and cell death in vitro and significantly reduced the growth of four in vivo models of MYCN-driven tumors, without major toxicities. Our data highlight the combination of PARP and CHK1 inhibitors as a new potential chemo-free strategy to treat MYCN-driven tumors, which might be promptly translated into clinical trials.

DOI: https://doi.org/10.1038/s41388-021-02003-0
Ann Oncol. 2021 Sep 03. pii: S0923-7534(21)04455-0. [Epub ahead of print]

Clinical definition of acquired resistance to immunotherapy in patients with metastatic non-small cell lung cancer.

A J Schoenfeld, S J Antonia, M M Awad, E Felip, J Gainor, S N Gettinger, F S Hodi, M L Johnson, N B Leighl, C M Lovly, T Mok, M Perol, M Reck, B Solomon, J-C Soria, D S W Tan, S Peters, M D Hellmann.

  Acquired resistance to PD-(L)1 blockade is frequent in non-small cell lung cancer (NSCLC), occurring in a majority of initial responders. Patients with acquired resistance may have unique properties of persistent anti-tumor immunity that could be re-harnessed by investigational immunotherapies. The absence of a consistent clinical definition of acquired resistance to PD-(L)1 blockade and lack of uniform criteria for ensuing enrollment in clinical trials remains a major barrier to progress; such clinical definitions have advanced biologic and therapeutic discovery. We examine the considerations and potential controversies in developing a patient-level definition of acquired resistance in NSCLC treated with PD-(L)1 blockade. Taking into account the specifics of NSCLC biology and corresponding treatment strategies, we propose a practical, clinical definition of acquired resistance to PD-(L)1 blockade for use in clinical reports and prospective clinical trials. Patients should meet the following criteria: received treatment that includes PD-(L)1 blockade; experienced objective response on PD-(L)1 blockade (inclusion of a subset of stable disease will require future investigation); have progressive disease occurring within 6 months of last anti-PD-(L)1 antibody treatment or rechallenge with anti-PD-(L)1 antibody in patients not exposed to anti-PD-(L)1 in 6 months.

Keywords:  PD-(L)1 blockade; acquired resistance; checkpoint inhibitor; immunotherapy; lung cancer

DOI:  https://doi.org/10.1016/j.annonc.2021.08.2151
J Clin Oncol. 2021 Sep 07. JCO2101430

Beyond Chemotherapy and Checkpoint Inhibitors: Weighing the Risks and Benefits of the Novel Therapies for Metastatic Urothelial Carcinoma.

Thomas Powles, Daniel P Petrylak, Jonathan E Rosenberg.

DOI: https://doi.org/10.1200/JCO.21.01430
Genome Med. 2021 Sep 10. 13(1): 148

Single-cell exome sequencing reveals multiple subclones in metastatic colorectal carcinoma.

Jie Tang, Kailing Tu, Keying Lu, Jiaxun Zhang, Kai Luo, Haoxuan Jin, Lei Wang, Lie Yang, Weiran Xiao, Qilin Zhang, Xiaoling Liu, Xin Yi Ge, Guibo Li, Zongguang Zhou, Dan Xie.

  BACKGROUND: Colorectal cancer (CRC) is a major cancer type whose mechanism of metastasis remains elusive.METHODS: In this study, we characterised the evolutionary pattern of metastatic CRC (mCRC) by analysing bulk and single-cell exome sequencing data of primary and metastatic tumours from 7 CRC patients with liver metastases. Here, 7 CRC patients were analysed by bulk whole-exome sequencing (WES); 4 of these were also analysed using single-cell sequencing.
RESULTS: Despite low genomic divergence between paired primary and metastatic cancers in the bulk data, single-cell WES (scWES) data revealed rare mutations and defined two separate cell populations, indicative of the diverse evolutionary trajectories between primary and metastatic tumour cells. We further identified 24 metastatic cell-specific-mutated genes and validated their functions in cell migration capacity.
CONCLUSIONS: In summary, scWES revealed rare mutations that failed to be detected by bulk WES. These rare mutations better define the distinct genomic profiles of primary and metastatic tumour cell clones.

Keywords:  Colorectal cancer, Single-cell DNA sequencing, Tumour metastasis

DOI:  https://doi.org/10.1186/s13073-021-00962-3
Gut. 2021 Sep 06. pii: gutjnl-2021-324852. [Epub ahead of print]

Genomic temporal heterogeneity of circulating tumour DNA in unresectable metastatic colorectal cancer under first-line treatment.

Feng Wang, You-Sheng Huang, Hao-Xiang Wu, Zi-Xian Wang, Ying Jin, Yi-Chen Yao, Yan-Xing Chen, Qi Zhao, Shifu Chen, Ming-Ming He, Hui-Yan Luo, Miao-Zhen Qiu, De-Shen Wang, Feng-Hua Wang, Mingyan Xu, Yu-Hong Li, Rui-Hua Xu.

  OBJECTIVE: Circulating tumour DNA (ctDNA) sequencing is increasingly used in the clinical management of patients with colorectal cancer. However, the genomic heterogeneity in ctDNA during treatments and its impact on clinical outcomes remain largely unknown.DESIGN: We conducted a prospective cohort study (NCT04228614) of 171 patients with unresectable metastatic colorectal cancer (mCRC) who underwent first-line treatment and prospectively collected blood samples with or without tumour samples from patients at baseline and sequentially until disease progression or last follow-up.
RESULTS: The RAS/BRAF alterations in paired baseline tissue and plasma samples from 63 patients displayed a favourable concordance (81.0%, 51/63). After a period of first-line treatment (median time between baseline and last liquid biopsy, 4.67 months), 42.6% (26/61) of RAS-mutant patients showed RAS clearance and 50.0% (5/10) of BRAF-mutant patients showed BRAF clearance, while 3.6% (3/84) and 0.7% (1/135) of patients showed new RAS or BRAF mutations in ctDNA. Patients with plasma RAS/BRAF clearance showed similar progression-free survival (PFS) and overall survival (OS) with patients who remained RAS/BRAF wild-type, while much better outcomes than those who remained RAS/BRAF mutant. Patients who gained new RAS/BRAF mutations showed similar prognosis as those who maintained RAS/BRAF mutations, and shorter PFS and OS than those who remained RAS/BRAF wild-type.
CONCLUSION: This prospective, serial and large-scale ctDNA profiling study reveals the temporal heterogeneity of mCRC-related somatic variants, which should be given special attention in clinical practice, as evidenced by the finding that the shift in plasma RAS/BRAF mutational status can yield a drastic change in survival outcomes.

Keywords:  cancer genetics; colorectal cancer genes; colorectal carcinoma

DOI:  https://doi.org/10.1136/gutjnl-2021-324852
Cell Rep. 2021 Sep 07. pii: S2211-1247(21)01118-9. [Epub ahead of print]36(10): 109674

Tumor-initiating stem cell shapes its microenvironment into an immunosuppressive barrier and pro-tumorigenic niche.

Xi He, Sarah E Smith, Shiyuan Chen, Hua Li, Di Wu, Paloma I Meneses-Giles, Yongfu Wang, Mark Hembree, Kexi Yi, Xia Zhao, Fengli Guo, Jay R Unruh, Lucinda E Maddera, Zulin Yu, Allison Scott, Anoja Perera, Yan Wang, Chongbei Zhao, KyeongMin Bae, Andrew Box, Jeffrey S Haug, Fang Tao, Deqing Hu, Darrick M Hansen, Pengxu Qian, Subhrajit Saha, Dan Dixon, Shrikant Anant, Da Zhang, Edward H Lin, Weijing Sun, Leanne M Wiedemann, Linheng Li.

  Tumor-initiating stem cells (TSCs) are critical for drug resistance and immune escape. However, the mutual regulations between TSC and tumor microenvironment (TME) remain unclear. Using DNA-label retaining, single-cell RNA sequencing (scRNA-seq), and other approaches, we investigated intestinal adenoma in response to chemoradiotherapy (CRT), thus identifying therapy-resistant TSCs (TrTSCs). We find bidirectional crosstalk between TSCs and TME using CellPhoneDB analysis. An intriguing finding is that TSCs shape TME into a landscape that favors TSCs for immunosuppression and propagation. Using adenoma-organoid co-cultures, niche-cell depletion, and lineaging tracing, we characterize a functional role of cyclooxygenase-2 (Cox-2)-dependent signaling, predominantly occurring between tumor-associated monocytes and macrophages (TAMMs) and TrTSCs. We show that TAMMs promote TrTSC proliferation through prostaglandin E2 (PGE2)-PTGER4(EP4) signaling, which enhances β-catenin activity via AKT phosphorylation. Thus, our study shows that the bidirectional crosstalk between TrTSC and TME results in a pro-tumorigenic and immunosuppressive contexture.

Keywords:  C5AR1; CD74; EP4; MIF; Pge2; RPS19; immune barrier; mciroenvironment; niche; resistance; stem cell

DOI:  https://doi.org/10.1016/j.celrep.2021.109674
Nat Rev Clin Oncol. 2021 Sep 06.

Clinical and therapeutic relevance of cancer-associated fibroblasts.

Yang Chen, Kathleen M McAndrews, Raghu Kalluri.

Cancer-associated fibroblasts (CAFs) found in primary and metastatic tumours are highly versatile, plastic and resilient cells that are actively involved in cancer progression through complex interactions with other cell types in the tumour microenvironment. As well as generating extracellular matrix components that contribute to the structure and function of the tumour stroma, CAFs undergo epigenetic changes to produce secreted factors, exosomes and metabolites that influence tumour angiogenesis, immunology and metabolism. Because of their putative pro-oncogenic functions, CAFs have long been considered an attractive therapeutic target; however, clinical trials of treatment strategies targeting CAFs have mostly ended in failure and, in some cases, accelerated cancer progression and resulted in inferior survival outcomes. Importantly, CAFs are heterogeneous cells and their characteristics and interactions with other cell types might change dynamically as cancers evolve. Studies involving single-cell RNA sequencing and novel mouse models have increased our understanding of CAF diversity, although the context-dependent roles of different CAF populations and their interchangeable plasticity remain largely unknown. Comprehensive characterization of the tumour-promoting and tumour-restraining activities of CAF subtypes, including how these complex bimodal functions evolve and are subjugated by neoplastic cells during cancer progression, might facilitate the development of novel diagnostic and therapeutic approaches. In this Review, the clinical relevance of CAFs is summarized with an emphasis on their value as prognosis factors and therapeutic targets.

DOI: https://doi.org/10.1038/s41571-021-00546-5
Nat Cell Biol. 2021 Sep 06.

EZH2 accompanies prostate cancer progression.

Li Xin.

DOI: https://doi.org/10.1038/s41556-021-00744-4
Biochim Biophys Acta Rev Cancer. 2021 Sep 01. pii: S0304-419X(21)00121-9. [Epub ahead of print]1876(2): 188623

Drug resistance in colorectal cancer: An epigenetic overview.

Maochao Luo, Xingyue Yang, Hai-Ning Chen, Edouard C Nice, Canhua Huang.

  Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Despite significant progress that has been made in therapies against CRC over the past decades, drug resistance is still a major limitation in CRC treatment. Numerous investigations have unequivocally shown that epigenetic regulation plays an important role in CRC drug resistance because of the high rate of epigenetic alterations in multiple genes during cancer development or drug treatment. Furthermore, the reversibility of epigenetic alterations provides novel therapeutic strategies to overcome drug resistance using small molecules, which can target non-coding RNAs or reverse histone modification and DNA methylation. In this review, we discuss epigenetic regulation in CRC drug resistance and the possible role of preventing or reversing CRC drug resistance using epigenetic therapy in CRC treatment.

Keywords:  Colorectal cancer; DNA methylation; Drug resistance; Histone modification; Noncoding RNA

DOI:  https://doi.org/10.1016/j.bbcan.2021.188623
Cell Rep. 2021 Sep 07. pii: S2211-1247(21)01109-8. [Epub ahead of print]36(10): 109665

Molecular features of exceptional response to neoadjuvant anti-androgen therapy in high-risk localized prostate cancer.

Alok K Tewari, Alexander T M Cheung, Jett Crowdis, Jake R Conway, Sabrina Y Camp, Stephanie A Wankowicz, Dimitri G Livitz, Jihye Park, Rosina T Lis, Alice Bosma-Moody, Meng Xiao He, Saud H AlDubayan, Zhenwei Zhang, Rana R McKay, Ignaty Leshchiner, Myles Brown, Steven P Balk, Gad Getz, Mary-Ellen Taplin, Eliezer M Van Allen.

  High-risk localized prostate cancer (HRLPC) is associated with a substantial risk of recurrence and disease mortality. Recent clinical trials have shown that intensifying anti-androgen therapies administered before prostatectomy can induce pathologic complete responses or minimal residual disease, called exceptional response, although the molecular determinants of these clinical outcomes are largely unknown. Here, we perform whole-exome and transcriptome sequencing on pre-treatment multi-regional tumor biopsies from exceptional responders (ERs) and non-responders (NRs, pathologic T3 or lymph node-positive disease) to intensive neoadjuvant anti-androgen therapies. Clonal SPOP mutation and SPOPL copy-number loss are exclusively observed in ERs, while clonal TP53 mutation and PTEN copy-number loss are exclusively observed in NRs. Transcriptional programs involving androgen signaling and TGF-β signaling are enriched in ERs and NRs, respectively. These findings may guide prospective validation studies of these molecular features in large HRLPC clinical cohorts treated with neoadjuvant anti-androgens to improve patient stratification.

Keywords:  AR; PTEN; RNA-seq; SPOP; SPOPL; TGF-β; TP53; neoadjuvant androgen pathway inhibition; phylogenetics; whole exome sequencing

DOI:  https://doi.org/10.1016/j.celrep.2021.109665
NPJ Precis Oncol. 2020 Sep 08. 4(1): 27

Feasibility and first reports of the MATCH-R repeated biopsy trial at Gustave Roussy.

Gonzalo Recondo, Linda Mahjoubi, Aline Maillard, Yohann Loriot, Ludovic Bigot, Francesco Facchinetti, Rastislav Bahleda, Anas Gazzah, Antoine Hollebecque, Laura Mezquita, David Planchard, Charles Naltet, Pernelle Lavaud, Ludovic Lacroix, Catherine Richon, Aurelie Abou Lovergne, Thierry De Baere, Lambros Tselikas, Olivier Deas, Claudio Nicotra, Maud Ngo-Camus, Rosa L Frias, Eric Solary, Eric Angevin, Alexander Eggermont, Ken A Olaussen, Gilles Vassal, Stefan Michiels, Fabrice Andre, Jean-Yves Scoazec, Christophe Massard, Jean-Charles Soria, Benjamin Besse, Luc Friboulet.

Unravelling the biological processes driving tumour resistance is necessary to support the development of innovative treatment strategies. We report the design and feasibility of the MATCH-R prospective trial led by Gustave Roussy with the primary objective of characterizing the molecular mechanisms of resistance to cancer treatments. The primary clinical endpoints consist of analyzing the type and frequency of molecular alterations in resistant tumours and compare these to samples prior to treatment. Patients experiencing disease progression after an initial partial response or stable disease for at least 24 weeks underwent a tumour biopsy guided by CT or ultrasound. Molecular profiling of tumours was performed using whole exome sequencing, RNA sequencing and panel sequencing. At data cut-off for feasibility analysis, out of 333 inclusions, tumour biopsies were obtained in 303 cases (91%). From these biopsies, 278 (83%) had sufficient quality for analysis by high-throughput next generation sequencing (NGS). All 278 samples underwent targeted NGS, 215 (70.9%) RNA sequencing and 222 (73.2%) whole exome sequencing. In total, 163 tumours were implanted in NOD scid gamma (NSG) or nude mice and 54 patient-derived xenograft (PDX) models were established, with a success rate of 33%. Adverse events secondary to invasive tumour sampling occurred in 24 patients (7.6%). Study recruitment is still ongoing. Systematic molecular profiling of tumours and the development of patient-derived models of acquired resistance to targeted agents and immunotherapy is feasible and can drive the selection of the next therapeutic strategy.

DOI: https://doi.org/10.1038/s41698-020-00130-7
Nature. 2021 Sep 08.

Using DNA sequencing data to quantify T cell fraction and therapy response.

Robert Bentham, Kevin Litchfield, Thomas B K Watkins, Emilia L Lim, Rachel Rosenthal, Carlos Martínez-Ruiz, Crispin T Hiley, Maise Al Bakir, Roberto Salgado, David A Moore, Mariam Jamal-Hanjani, , Charles Swanton, Nicholas McGranahan.

The immune microenvironment influences tumour evolution and can be both prognostic and predict response to immunotherapy1,2. However, measurements of tumour infiltrating lymphocytes (TILs) are limited by a shortage of appropriate data. Whole-exome sequencing (WES) of DNA is frequently performed to calculate tumour mutational burden and identify actionable mutations. Here we develop T cell exome TREC tool (T cell ExTRECT), a method for estimation of T cell fraction from WES samples using a signal from T cell receptor excision circle (TREC) loss during V(D)J recombination of the T cell receptor-α gene (TCRA (also known as TRA)). TCRA T cell fraction correlates with orthogonal TIL estimates and is agnostic to sample type. Blood TCRA T cell fraction is higher in females than in males and correlates with both tumour immune infiltrate and presence of bacterial sequencing reads. Tumour TCRA T cell fraction is prognostic in lung adenocarcinoma. Using a meta-analysis of tumours treated with immunotherapy, we show that tumour TCRA T cell fraction predicts immunotherapy response, providing value beyond measuring tumour mutational burden. Applying T cell ExTRECT to a multi-sample pan-cancer cohort reveals a high diversity of the degree of immune infiltration within tumours. Subclonal loss of 12q24.31-32, encompassing SPPL3, is associated with reduced TCRA T cell fraction. T cell ExTRECT provides a cost-effective technique to characterize immune infiltrate alongside somatic changes.

DOI: https://doi.org/10.1038/s41586-021-03894-5
Nat Genet. 2021 Sep;53(9): 1348-1359

Genomic and evolutionary classification of lung cancer in never smokers.

Tongwu Zhang, Philippe Joubert, Naser Ansari-Pour, Wei Zhao, Phuc H Hoang, Rachel Lokanga, Aaron L Moye, Jennifer Rosenbaum, Abel Gonzalez-Perez, Francisco Martínez-Jiménez, Andrea Castro, Lucia Anna Muscarella, Paul Hofman, Dario Consonni, Angela C Pesatori, Michael Kebede, Mengying Li, Bonnie E Gould Rothberg, Iliana Peneva, Matthew B Schabath, Maria Luana Poeta, Manuela Costantini, Daniela Hirsch, Kerstin Heselmeyer-Haddad, Amy Hutchinson, Mary Olanich, Scott M Lawrence, Petra Lenz, Maire Duggan, Praphulla M S Bhawsar, Jian Sang, Jung Kim, Laura Mendoza, Natalie Saini, Leszek J Klimczak, S M Ashiqul Islam, Burcak Otlu, Azhar Khandekar, Nathan Cole, Douglas R Stewart, Jiyeon Choi, Kevin M Brown, Neil E Caporaso, Samuel H Wilson, Yves Pommier, Qing Lan, Nathaniel Rothman, Jonas S Almeida, Hannah Carter, Thomas Ried, Carla F Kim, Nuria Lopez-Bigas, Montserrat Garcia-Closas, Jianxin Shi, Yohan Bossé, Bin Zhu, Dmitry A Gordenin, Ludmil B Alexandrov, Stephen J Chanock, David C Wedge, Maria Teresa Landi.

Lung cancer in never smokers (LCINS) is a common cause of cancer mortality but its genomic landscape is poorly characterized. Here high-coverage whole-genome sequencing of 232 LCINS showed 3 subtypes defined by copy number aberrations. The dominant subtype (piano), which is rare in lung cancer in smokers, features somatic UBA1 mutations, germline AR variants and stem cell-like properties, including low mutational burden, high intratumor heterogeneity, long telomeres, frequent KRAS mutations and slow growth, as suggested by the occurrence of cancer drivers' progenitor cells many years before tumor diagnosis. The other subtypes are characterized by specific amplifications and EGFR mutations (mezzo-forte) and whole-genome doubling (forte). No strong tobacco smoking signatures were detected, even in cases with exposure to secondhand tobacco smoke. Genes within the receptor tyrosine kinase-Ras pathway had distinct impacts on survival; five genomic alterations independently doubled mortality. These findings create avenues for personalized treatment in LCINS.

DOI: https://doi.org/10.1038/s41588-021-00920-0
Oncogene. 2021 Sep 06.

FOXK2 transcriptionally activating VEGFA induces apatinib resistance in anaplastic thyroid cancer through VEGFA/VEGFR1 pathway.

Haoran Feng, Zhijian Jin, Juyong Liang, Qiwu Zhao, Ling Zhan, Zheyu Yang, Jiqi Yan, Jie Kuang, Xi Cheng, Weihua Qiu.

Anaplastic thyroid carcinoma (ATC) is a rare and extremely aggressive type of thyroid cancer, and the potential mechanisms involved in ATC progression remains unclarified. In this study, we found that forkhead box K2 (FOXK2) was upregulated in ATC tissues, and the expression of FOXK2 was associated with tumor size. Evidenced by RNA-seq and Chromatin immunoprecipitation (ChIP)-seq assays, FOXK2 positively regulated VEGF and VEGFR signaling network, among which only VEGFA could be noticed in both RNA-seq and ChIP-seq results. ChIP, dual-luciferase reporter system and functional experiments further confirmed that FOXK2 promoted angiogenesis by inducing the transcription of VEGFA. On VEGFR2 blockage by specific targeting agent, such as Apatinib, FOXK2 could rapidly trigger therapeutic resistance. Mechanical analyses revealed that VEGFA transcriptionally induced by FOXK2 could bind to VEGFR1 as a compensation for VEGFR2 blockage, which promoted angiogenesis by activating ERK, PI3K/AKT and P38/MAPK signaling in human umbilical vein endothelial cells (HUVECs). Synergic effect on anti-angiogenesis could be observed when VEGFR1 suppressor AF321 was included in VEGFR2 inhibition system, which clarified the pivot role of FOXK2 in VEGFR2 targeting therapy resistance. More importantly, the binding of VEGFA to VEGFR1 could further promoter FOXK2-mediated VEGFA transcription, which consequently constituted a positive feedback loop. Therefore, the novel loop VEGFA/VEGFR1/FOXK2 functioned importantly in resistance to VEGFR2 targeting therapy in FOXK2+ ATCs. Altogether, FOXK2 plays critical roles in ATC angiogenesis and VEGFR2 blockage resistance by inducing VEGFA transcription. FOXK2 represents a potentially new therapeutic strategy and biomarker for anti-angiogenic therapy against ATC.

DOI: https://doi.org/10.1038/s41388-021-01830-5