1. Mechanistic Distinctions between CHK1 and WEE1 Inhibition Guide the Scheduling of Triple Therapy with Gemcitabine.
- Author
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Koh SB, Wallez Y, Dunlop CR, Bernaldo de Quirós Fernández S, Bapiro TE, Richards FM, and Jodrell DI
- Subjects
- Animals, Cell Line, Tumor, Cell Proliferation drug effects, DNA Damage drug effects, DNA Replication drug effects, Deoxycytidine pharmacology, Drug Synergism, Female, Humans, Mice, Mice, Inbred BALB C, Mice, Nude, Xenograft Model Antitumor Assays methods, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols pharmacology, Cell Cycle Proteins antagonists & inhibitors, Checkpoint Kinase 1 antagonists & inhibitors, Deoxycytidine analogs & derivatives, Nuclear Proteins antagonists & inhibitors, Protein-Tyrosine Kinases antagonists & inhibitors
- Abstract
Combination of cytotoxic therapy with emerging DNA damage response inhibitors (DDRi) has been limited by tolerability issues. However, the goal of most combination trials has been to administer DDRi with standard-of-care doses of chemotherapy. We hypothesized that mechanism-guided treatment scheduling could reduce the incidence of dose-limiting toxicities and enable tolerable multitherapeutic regimens. Integrative analyses of mathematical modeling and single-cell assays distinguished the synergy kinetics of WEE1 inhibitor (WEE1i) from CHEK1 inhibitor (CHK1i) by potency, spatiotemporal perturbation, and mitotic effects when combined with gemcitabine. These divergent properties collectively supported a triple-agent strategy, whereby a pulse of gemcitabine and CHK1i followed by WEE1i durably suppressed tumor cell growth. In xenografts, CHK1i exaggerated replication stress without mitotic CDK hyperactivation, enriching a geminin-positive subpopulation and intratumoral gemcitabine metabolite. Without overt toxicity, addition of WEE1i to low-dose gemcitabine and CHK1i was most effective in tumor control compared with single and double agents. Overall, our work provides quantitative insights into the mechanisms of DDRi chemosensitization, leading to the rational development of a tolerable multitherapeutic regimen. Significance: Multiple lines of mechanistic insight regarding DNA damage response inhibitors rationally guide the preclinical development of a tolerable multitherapeutic regimen. Graphical Abstract: http://cancerres.aacrjournals.org/content/canres/78/11/3054/F1.large.jpg Cancer Res; 78(11); 3054-66. ©2018 AACR ., (©2018 American Association for Cancer Research.)
- Published
- 2018
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