targeting the igf pathway in pediatric sarcomas-lessons ... · targeting the igf pathway in...
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Targeting the IGF Pathway in Pediatric Sarcomas-Lessons
Learned and Questions Raised
Lee J. Helman, M.D.Scientific Director for Clinical
Research,Center for Cancer Research, NCI
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Role of IGF Signaling-Previous Studies
• IGFII is an autocrine growth and motility factor in rhabdomyosarcoma (El-Badry et al. Cell Growth and Diff 1990)
• Loss of Imprinting (LOI) of IGFII in Rhabdomyosarcomas (Zhan S, Shapiro DN, and Helman LJ JCI 1994)
• LOI of IGFII in Ewing’s Sarcoma (Zhan S, Shapiro DN, and Helman LJ Oncogene 1995)
• IGFIR is required for EWS-FLI-1 transformation of fibroblastsI (Toretsky J. et al. JBC 1997)
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Previous Studies • IGF-II overexpression in C2 myoblasts led to
diminished G1 checkpoint (Zhang et al. JBC 1999)
• Resistance to apoptosis most directly correlated with phosphorylation of p70S6 kinase and 4E-BP-1. Resistance to apoptosis in IGF-II overexpressing cells was reversed by rapamycin (Wan and Helman Neoplasia 2002)
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Rapalogs and IGF Signaling
• Demonstrated that rapalog treatment of RMS leads to activation of Akt in vivo
• Demonstrated that this activation is IGF dependent and can be blocked with IGFIR blockade (Wan et al. Oncogene 2006)
• Proteomic analysis of Dx tumor biopsies in Stage III RMS demonstrated activation of mTOR pathway proteins predicted poor DFS in both ERMS and ARMS (Petricoin EF et al. Ca Res 2007)
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IRS-1 PI3K PIP2 PIP3
PTEN PDK1
PKB/Akt
S473
TSC1
TSC2
Rheb
mTOR RaptormLST8
mTOR RictormLST8
LKB1
AMPK
Rapamycin
FKBP12
NutrentsGF(insulin/IGF)
S6K1 4E-BP1
elF4B elF4ErpS6
Top-dependent translation (e.g. IGF-II)
Cap-dependent translation (e.g. Cyclin D1, c-MYC, HIF-1,VEGF)
Actin cytoskeleton
RTK
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Preclinical Studies with human IGFIR Ab
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Cao, L,,et al. Ca Res 2008
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Conclusions• Early evidence to suggest beneficial
combination of mTOR inhibition combined with IGFIR inhibition
• Effect of IGFIR inhibition correlates with IGFIR levels
• Effect of IGFIR blockade on decrease in pAkt is lost in long-term xenografts, and this “tachphylaxis” is abrogated with mTOR inhibtion
• Raises question of whether Ab should be stopped in patients who respond and then progress
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IRS-1 PI3K PIP2 PIP3
PTEN PDK1
PKB/Akt
S473
TSC1
TSC2
Rheb
mTOR RaptormLST8
mTOR RictormLST8
LKB1
AMPK
Rapamycin
FKBP12
NutrentsGF(insulin/IGF)
S6K1 4E-BP1
elF4B elF4ErpS6
Top-dependent translation (e.g. IGF-II)
Cap-dependent translation (e.g. Cyclin D1, c-MYC, HIF-1,VEGF)
Actin cytoskeleton
RTK
Other RTK?
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Clinical Studies in Ewing’s and other Sarcomas
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A B C
44 year old US farmer with third systemic relapse of Ewing’s sarcoma
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17 yo boy with multiply recurrent Ewing’s sarcoma
Baseline CT Chest Week 6 CT Chest
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Refractory 25yo with EWS and Retinal Metastasis Rx with R1507
Baseline Week 6
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9/9/08 NIH MRI
9/9/08 NIH PET CT: Right orbital mass SUV 4.7
1.6 X 1.4 X 1.6 CM
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10/14/08 NIH MRI
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Conclusions• IGFIRAb 1507 has good clinical activity in EWS and
perhaps RMS– No mutations found in pathway to date
• Preclinical models did not accurately predict dramatic tumor shrinkage, but did predict activity
• Response rates less than 50%, so challenge is to identify factors that predict good response
• Must find ways to combine with other targeted Rx and or ChemoRx
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IGF-1R/InRIRS-1
PI3K
Akt
TSC1/2
mTORC1
S6K1 4E-BP1
Rheb Rapalogs
mTORC2
LY294002
Akt inhibitors
mTORC1and mTORC2inhibtion with kinase inhibitors ?
IGF-1R AbTK inhibitors
PI3K/mTOR inhibitors
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Liang Cao (not shown) Lee Helman
Chand Khanna Choh Yeung Issac Darko(not shown)Sung-Hyeok Hong
Xiaolin Wan Patrick Grohar Duane Currier (not shown)