Abstract B039: Development of a selective therapeutic intervention for p53 mutant for pancreatic adenocarcinoma

Abstract Genetic alterations in the tumor suppressor p53 gene (TP53) are found in over 70% of Pancreatic Adenocarcinoma (PAAD) and contribute to poor prognosis, cancer progression and metastasis. Existing treatment options for p53 mutant (p53mut) cancer are limited and there is an urgent need for better therapeutic interventions that can be greatly beneficial to a large proportion of patients with PAAD. Here we present a novel therapeutic strategy for selective targeting p53mut pancreatic tumors. Genomic data revealed that p53-deficient PAADs express high levels of DNA replication genes as well as genes involved in Base Excision (BER) and Mismatch (MMR) Repair, indicating activation of these mechanisms. Evaluation of BER activity by a novel methodology with a modified deoxyuridine analogue showed a significant dysregulation in BER mediated repair in p53mut cancer cells leading to accumulation of p53mut tumor cells in late S/G2 phase. By exploiting this defect, we found that treatment with a deoxyuridine analogue such as trifluorothymidine (TFT, a component of TAS102) resulted in accumulation of DNA breaks selectively in p53mut cells. A deoxyuridine analogue (TFT) did not block DNA replication but rather activated DNA repair leading to DNA breaks in p53mut cells whereas p53 wild type cells accumulated in G1 with minimal DNA damage. Further, we found that inhibition of poly (ADP) ribose polymerase (PARP) enhanced DNA damage and increased cell death selectively in p53mut tumor cells although PARP inhibitor alone was not effective. In contrast, the TAS102-PARPi did not induce DNA damage in the normal cells such as hTERT-immortalized Human Pancreatic Nestin Expressing cells (HPNE). A new TAS102-PARPi combination regimen demonstrated greater inhibition of tumor growth and improved the survival rates in p53mut PAAD xenograft models including Cell-Derived Xenograft (CDX) and Patient-Derived xenograft (PDX) models, compared to either drug alone without adverse effects in mice. Thus, this preclinical work identified a novel and immediately feasible strategy for p53mut disease that may improve treatment and the quality of life for a significant proportion of patients with PAAD while limiting toxic effects on normal tissues. Citation Format: Mohammed M. Alruwaili, Justin Zonneville, Mohammed A. Alqarni, Priyanka Rajan, Hannah Serio, Robert Straubinger, Christos Fountzilas, Andrei Bakin. Development of a selective therapeutic intervention for p53 mutant for pancreatic adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B039.