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Rigshospitalet - a part of Copenhagen University Hospital
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Identification of a Synthetic Lethal Relationship between Nucleotide Excision Repair Deficiency and Irofulven Sensitivity in Urothelial Cancer

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  • Judit Börcsök
  • Zsofia Sztupinszki
  • Raie Bekele
  • Sizhi P Gao
  • Miklos Diossy
  • Amruta S Samant
  • Kasia M Dillon
  • Viktoria Tisza
  • Sándor Spisák
  • Orsolya Rusz
  • Istvan Csabai
  • Helle Pappot
  • Zoe J Frazier
  • David J Konieczkowski
  • David Liu
  • Naresh Vasani
  • James A Rodrigues
  • David B Solit
  • Jean H Hoffman-Censits
  • Elizabeth R Plimack
  • Jonathan E Rosenberg
  • Jean-Bernard Lazaro
  • Mary-Ellen Taplin
  • Gopa Iyer
  • Søren Brunak
  • Rita Lozsa
  • Eliezer M Van Allen
  • Dávid Szüts
  • Kent W Mouw
  • Zoltan Szallasi
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PURPOSE: Cisplatin-based chemotherapy is a first-line treatment for muscle-invasive and metastatic urothelial cancer. Approximately 10% of bladder urothelial tumors have a somatic missense mutation in the nucleotide excision repair (NER) gene, ERCC2, which confers increased sensitivity to cisplatin-based chemotherapy. However, a significant subset of patients is ineligible to receive cisplatin-based therapy due to medical contraindications, and no NER-targeted approaches are available for platinum-ineligible or platinum-refractory ERCC2-mutant cases.

EXPERIMENTAL DESIGN: We used a series of NER-proficient and NER-deficient preclinical tumor models to test sensitivity to irofulven, an abandoned anticancer agent. In addition, we used available clinical and sequencing data from multiple urothelial tumor cohorts to develop and validate a composite mutational signature of ERCC2 deficiency and cisplatin sensitivity.

RESULTS: We identified a novel synthetic lethal relationship between tumor NER deficiency and sensitivity to irofulven. Irofulven specifically targets cells with inactivation of the transcription-coupled NER (TC-NER) pathway and leads to robust responses in vitro and in vivo, including in models with acquired cisplatin resistance, while having minimal effect on cells with intact NER. We also found that a composite mutational signature of ERCC2 deficiency was strongly associated with cisplatin response in patients and was also associated with cisplatin and irofulven sensitivity in preclinical models.

CONCLUSIONS: Tumor NER deficiency confers sensitivity to irofulven, a previously abandoned anticancer agent, with minimal activity in NER-proficient cells. A composite mutational signature of NER deficiency may be useful in identifying patients likely to respond to NER-targeting agents, including cisplatin and irofulven.

Original languageEnglish
JournalClinical Cancer Research
Volume27
Issue number7
Pages (from-to)2011-2022
Number of pages12
ISSN1078-0432
DOIs
Publication statusPublished - 1 Apr 2021

ID: 61758605