Open AccessRepurposing Vandetanib plus Everolimus for the Treatment ofACVR1-Mutant Diffuse Intrinsic Pontine Glioma
Author(s) -
Diana Carvalho,
Peter J. Richardson,
Nagore G. Olaciregui,
Reda Stankunaite,
Cinzia Lavarino,
Valeria Molinari,
Elizabeth A. Corley,
Daniel P. Smith,
Ruth Ruddle,
Adam Donovan,
Ákos Pál,
Florence I. Raynaud,
Sara Temelso,
Alan Mackay,
John P. Overington,
Anne M. Phelan,
David P. Sheppard,
Andrew D. MacKin,
Bassel Zebian,
Safa AlSarraj,
Ashirwad Merve,
Jeremy Pryce,
Jacques Grill,
Michael Hubank,
Oliveira Cruz,
Andres Morales La Madrid,
Sabine Mueller,
Ángel M. Carcaboso,
Fernando Carceller,
Chris Jones
Publication year - 2021
Publication title -
cancer discovery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.795
H-Index - 163
eISSN - 2159-8290
pISSN - 2159-8274
DOI - 10.1158/2159-8290.cd-20-1201
Subject(s) - vandetanib , everolimus , medicine , pharmacology , cancer research , oncology , sorafenib , hepatocellular carcinoma
Somatic mutations in ACVR1 are found in a quarter of children with diffuse intrinsic pontine glioma (DIPG), but there are no ACVR1 inhibitors licensed for the disease. Using an artificial intelligence-based platform to search for approved compounds for ACVR1 -mutant DIPG, the combination of vandetanib and everolimus was identified as a possible therapeutic approach. Vandetanib, an inhibitor of VEGFR/RET/EGFR, was found to target ACVR1 ( K d = 150 nmol/L) and reduce DIPG cell viability in vitro but has limited ability to cross the blood-brain barrier. In addition to mTOR, everolimus inhibited ABCG2 (BCRP) and ABCB1 (P-gp) transporters and was synergistic in DIPG cells when combined with vandetanib in vitro . This combination was well tolerated in vivo and significantly extended survival and reduced tumor burden in an orthotopic ACVR1 -mutant patient-derived DIPG xenograft model. Four patients with ACVR1 -mutant DIPG were treated with vandetanib plus an mTOR inhibitor, informing the dosing and toxicity profile of this combination for future clinical studies. SIGNIFICANCE: Twenty-five percent of patients with the incurable brainstem tumor DIPG harbor somatic activating mutations in ACVR1 , but there are no approved drugs targeting the receptor. Using artificial intelligence, we identify and validate, both experimentally and clinically, the novel combination of vandetanib and everolimus in these children based on both signaling and pharmacokinetic synergies. This article is highlighted in the In This Issue feature, p. 275 .