High sensitivity of BRCA1 deficient mammary tumors to the PARP inhibitor AZD2281 alone and in combination with platinum drugs
Whereas target specific drugs are available for treating ERBB2 overexpressing and hormone receptor positive breast cancers, no tailored therapy exists for hormone receptor and ERBB2 negative "triple negative" mammary carcinomas. Triple negative tumors account for 15% of all breast cancers and frequently harbor defects in DNA double strand break repair through homologous recombination (HR) such as BRCA1 dysfunction. The DNA repair defects characteristic of BRCA1 deficient cells confer sensitivity to poly(ADP ribose) polymerase 1 (PARP1) inhibition, which could be relevant to treatment of triple negative tumors. To evaluate PARP1 inhibition in a realistic in vivo setting, we tested the PARP inhibitor AZD2281 in a genetically engineered mouse model (GEMM) for BRCA1 associated breast cancer. Treatment of tumor bearing mice with AZD2281 inhibited tumor growth without signs of toxicity, resulting in strongly increased survival. Long term treatment with AZD2281 in this model did result in the development of drug resistance, caused by up regulation of Abcb1a/b genes encoding P glycoprotein efflux pumps. This resistance to AZD2281 could be reversed by coadministration of the P glycoprotein inhibitor tariquidar. Combination of AZD2281 with cisplatin or carboplatin increased the recurrence free and overall survival, suggesting that AZD2281 potentiates the effect of these DNA damaging agents. Our results demonstrate in vivo efficacy of AZD2281 against BRCA1 deficient breast cancer and illustrate how GEMMs of cancer can be used for preclinical evaluation of novel therapeutics and for testing ways to overcome or circumvent therapy resistance.
Proceedings of the National Academy of Sciences