Background: Resistance to CDK4/6 inhibitors (CDK4/6i) has been well studied with several mechanisms identified, including loss of RB, FAT1, and ERa and altered expression of regulatory genes such as CCND1, CCNE1/2, and CDK2. Additionally, alterations responsible for resistance may be linked to duration of CDK4/6i treatment. Previously (AACR2023), we reported on seventeen ER+ breast XPDX models representing patients who responded to CDK4/6i for up to twelve months (RES12), and greater than one year (RES13+). To better understand if duration of clinical treatment correlates with unique resistance mechanisms, we established and characterized an additional fifteen breast XPDX models from patients post-CDK4/6i and compared molecular profiles and drug sensitivities in the panel of thirty-two models. Methods: Seventeen breast models were previously established and characterized which included 8xRES12 and 9xRES13+. Fifteen new models were established from thirteen patients: eleven originated from fluid samples of which seven were designated as ductal (ST4137L, ST4322C, ST4322D, ST6023B, STM185, STM188, ST188B) and four as lobular carcinomas (ST4680D, ST6133, STM229F, ST383F); three were established from core biopsies (ST4534B, lymph node; ST5400, breast; STM354, liver), and one from circulating tissue (STM223B), all designated as ductal carcinomas. Of the fifteen new models, six were classified as RES12 and nine as RES13+. These models were passaged and challenged with palbociclib to confirm resistance. Receptor expression was determined by IHC and genomic analyses, including WES and RNAseq, were performed to identify mechanisms of resistance. For in vivo studies, CDK4/6i were dosed via oral gavage, once daily at 50 mg/kg; endpoints included tumor volume (TV) and time from treatment initiation (TTI) with %T/C values and tumor regression reported at study completion; a %T/C of ≤20 versus control was considered sensitive. Tumor regression (%T/C<0) versus Day 0 TV was also reported. Results: Clinical time to progression (TTP) for RES12 (n=6) was four to twelve months and RES13+ (n=9) from thirteen to thirty-six months. All models, except ST4322C and ST4322D, retained ER expression in evaluated passages with similar histology compared with archival clinical samples. Sequencing identified several variants, including RB1 and/or PTEN loss or deletion, and increased gene expression in CCND1, CCNE1, and the PIK3CA/AKT pathway. PIK3CA mutations were reported in 7/15 models; mutations in RAF1, ESR1, FGFR and other genes were also identified across the panel, some more prevalent based on clinical TTP. Most models were resistant to fulvestrant and insensitive to some or all evaluated CDK4/6i treatments. Conclusion: We have expanded our platform of breast XPDX from patients post-CDK4/6i treatment to thirty-two models and characterized each based-on duration of clinical treatment, molecular profiles, and drug sensitivities. We have also identified potential mechanisms of resistance based on CDK4/6i therapy and TTP. This platform is a valuable resource for developing novel therapies for CDK4/6i-resistant patients. Citation Format: Delaney Rushing, Alyssa Simonson, Johnnie Flores, Anna Stackpole, Morgan Lynch, Amy Cook, Lisa Gonzales, Jim Lund, Tahmineh Rouzbahani, Eliza Abdul, Kyriakos Papadopoulos, Gladys Rodriguez, Lorena Mozas, Lorena Gonzalez, Amita Patnaik, Amy Lang, Murali Beeram, Manish Sharma, Emiliano Calvo, Tatiana Hernandez, Michael J. Wick. CDK4/6 inhibitor resistance in patients with ER+ breast cancer: Identification and characterization of resistance mechanisms in thirty-two XPDX models [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-02-20.

Abstract Background: Therapies targeting mutated phosphoinositide 3-kinase (PI3K) p110α catalytic subunit (PIK3CA) cancers remain an active field of research. Alpelisib was approved in combination with fulvestrant in ER+/HER2- breast cancer patients harboring PIK3CA mutations on hotspot amino acids E542, E545 Q546 or H1047. While mutation at these sites have been widely studied, they only comprise ~25% of identified variants in this protein. Recent studies have reported other mutations, including those at the c-terminus, which can lead to constitutive activation of PIK3CA; however, whether these variants are sensitive to agents like alpelisib is unclear. To better understand these variants and their role in PIK3CA-mediated breast cancer, we established a panel of PIK3CA-mutated ER+ and ER- breast XPDX models and evaluated each in vivo with single agent alpelisib. Methods: Ninety previously developed XPDX models representing PIK3CA-mutated ER+ and ER- breast cancer were evaluated in this study. Models were grown subcutaneously in female athymic nude mice supplemented with estradiol in drinking water when necessary and ER expression confirmed at multiple passes; PIK3A variants were determined by WES and RNAseq. For in vivo studies, alpelisib was administered once daily by oral gavage at 35 mg/kg through study completion. Endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a T/C of ≤ 20% versus control was considered sensitive. Tumor regression (%T/C< 0%) versus Day 0 tumor volume was also reported. Results: 60% of PIK3CA-mutated models were found ER+ with 40% also HER2+ while 20% of ER- PIK3CA-mutated models were also HER2+. H1047X mutations accounted for 40% of all PIK3CA variants, 75% of which were single or dual PIK3CAH1047R. Several hotspot-mutated models were sensitive to alpelisib some with regressions including ST986 (E542K), ST1097 (E454K) and STF040 (H1047R), as well as ST1245C (R88Q/N1044H), ST2076 (102-103ins/R357Q) and ST4176 (E726K/H1047R). HER2+ models were less sensitive to alpelisib although STM148D (H1047L) reported tumor regressions. Interestingly, ST1799/PBR (E542K/H1065L), a palbociclib resistant clone of the ER+ parent ST1799 model was resistant to alpelisib while the parent was found sensitive. Conclusion: We have benchmarked a panel of PIK3CA-mutated breast XPDX models with alpelisib and compared activity of models harboring hotspot versus uncommon PIK3CA mutations with ER and HER2 expression. This data is a valuable tool in further developing PIK3CA inhibitors and identifying new variant targets in breast cancer. Citation Format: Mercedes Castaneda, Alyssa Simonson, Johnnie Flores, Maci DeBoer, Jim Lund, Tahmi Rouzbahan, Kyriakos P. Papadopoulos, Amy Lang, Gladys Rodriguez, Maryam Elmi, Arthur Rosenthal, Drew Rasco, Victor Moreno, Amita Patnaik, Tatiana Hernandez, Emiliano Calvo, Lon Smith, Manish Sharma, Muralidhar Beeram, Michael Wick. Activity of alpelisib in a panel of breast XPDX models harboring hotspot and uncommon PIK3CA mutations [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-26-03.

Abstract EV is a Nectin-4 targeting antibody-drug conjugate (ADC) with an MMAE payload, recently approved for treatment of bladder cancer patients. To better understand the potential for EV in treatment of breast cancer, we evaluated 175 breast XPDX models, including hormone receptor positive and negative cancer, some with actionable mutations, representing primary and metastatic disease from naïve or clinically treated patients. Each model was stained and scored for Nectin-4 protein and evaluated in vivo against single agent EV and activity correlated with ER status, Nectin-4 staining and known variants. 175 breast XPDX models were evaluated in this study, approximately 35% representing estrogen receptor positive and 20% clinically HER2+ cancers. Nectin-4 protein expression based on intensity and proportion was determined on a scale of 0+-3+, and models profiled using WES and RNAseq. For in vivo studies, models were evaluated against single agent EV administered by intravenous injection once weekly for three cycles at 3 mg/kg. Endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a T/C of ≤ 20% versus control was considered sensitive. Tumor regression (%T/C< 0%) versus Day 0 tumor volume was also reported. Overall, 40% of breast models stained positive for Nectin-4 including 50% of ER- and 20% of ER+ and 50% of HER2+ models. For ER- models, 50% were negative and 40% stained 1+ while 80% of ER+ models were negative and 15% stained 1+. In vivo, 25% of models were sensitive to EV, with 65% of these models ER- and < 10% HER2+. Nectin-4 staining did not directly correlate to model sensitivity although models with known drivers such as AKT1 and ESR1 were insensitive as were several models established from post CDK4/6i patients. We have characterized a panel of breast XPDX models based on Nectin-4 staining and in vivo sensitivity to EV and correlated activity with protein and receptor staining and known mutations. This data is a valuable tool in further developing EV and identifying its potential in treating breast cancer. Citation Format: Crystal Moreno, Johnnie Flores, Alyssa Simonson, Maci DeBoer, Natalia Banos, Armando Diaz III, Morgan Lynch, Jim Lund, Leonora Leykum, Tahmi Rouzbahan, Manuel Pedregal, Kyriakos P. Papadopoulos, Amy Lang, Arthur Rosenthal, Drew Rasco, Gladys Rodriguez, Luis Rodriguez, Nehal Lakhani, Muralidhar Beeram, Amita Patnaik, Maria De Miguel, Ronald Drengler, Steven Abbate, Bernard Doger de Speville Uribe, Michael Wick. Enfortumab vedotin (EV): Correlation of estrogen receptor status and Nectin-4 expression with single agent efficacy in breast XPDX models [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-26-02.

Background: Trastuzumab deruxtecan (T-DXd) is an ADC consisting of an anti-HER2 antibody linked to a novel topoisomerase I inhibitor payload approved for T-DM1-refractory, HER2+ breast cancer (BC) and metastatic, recurrent HER2-low BC. While this therapy is effective in some patients, resistance often develops. To aid in developing new therapies for T-DXd-resistant BC and better understand potential resistance mechanisms, we established a panel of six breast XPDX models representing innate or acquired resistance to T-DXd. These models, designated ST4565C, ST4565D, STM148B, STM148C, STM148D, and ST4480B/EHR were developed and characterized for receptor expression, genomics, and drug sensitivities toward chemotherapies and targeted agents including T-DXd, T-DM1, and margetuximab. Methods: ST4565C/D was established from a patient with ER+/HER2+, metastatic BC who was T-DXd treatment naïve. ST4565C was collected post chemo- and HER2-targeted therapies; ST4565D was collected following eribulin/margetuximab. STM148B/C/D were established from a patient with ER-/HER2+ metastatic BC following trastuzumab, T-DM1, and eleven months of T-DXd. ST4480B/EHR was established by chronic in vivo T-DXd dosing to the parent ST4480B ER+/HER2+ model until resistance developed. Resulting models were passaged and receptor expression confirmed by IHC and genomic analyses, including WES and RNAseq, were performed to further characterize models. In vivo, models were tested with agents including: trastuzumab, T-DM1, and T-DXd; endpoints included tumor volume (TV) and time from treatment initiation (TTI) with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Tumor regression (%T/C=<0) versus Day 0 TV was also reported. Results: Models retained receptor expression and similar histology comparable with archival clinical or model samples. In vivo, all ST4565 and STM148 models were refractory to trastuzumab, T-DM1, and T-DXd up to 10 mg/kg weekly with an average %T/C of 75%. ST4480B/EHR showed similar resistance to trastuzumab and T-DM1 at 10 mg/kg, and T-DXd at 3 mg/kg; T-DXd tested at 3 mg/kg in the ST4480B parent model resulted in tumor regressions. Sequencing of ST4565C/D identified a novel fusion, MTAP/CDKN2A/B deletions and elevated expression of FGFR1 and CCND1. In STM148 models an AKAP8L-NOTCH3 fusion and PIK3CA and CCNE1 mutations were reported. ST4480B/EHR reported PIK3CAE545K and an ESR1-CCDC170 fusion identical to the parent model, but differential expression was noted in several genes in the RICTOR/TORC2 pathway. Conclusion: We established and characterized six breast XPDX models representing innate or acquired resistance to T-DXd. These models are valuable tools in understanding resistance mechanisms and in developing novel therapies for T-DXd-resistant patients. Citation Format: Maci DeBoer, Albert Paez, Johnnie Flores, Robyn Baeza, Alyssa Simonson, Jim Lund, Kyriakos Papadopoulos, Thomas Gribbin, Amy Lang, Gladys Rodriguez, Lorena Mozas, Lorena Gonzalez, Manish Sharma, Emiliano Calvo, Tatiana Hernandez, Michael J. Wick. Establishment and characterization of a panel of breast XPDX models representing innate or acquired resistance to trastuzumab deruxtecan (T-DXd). [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3855.

Background: Trastuzumab deruxtecan (DS-8201a) is an antibody-drug conjugate (ADC), consisting of a humanized anti-HER2 (human epidermal growth factor receptor 2) monoclonal antibody linked to a topoisomerase I inhibitor payload using a cleavable tetrapeptide-based linker, approved for the treatment of HER2+ metastatic breast cancer patients refractory to anti-HER2 therapy including T-DM1. While some mechanisms for clinical T-DM1 resistance have been identified, less is known about innate or acquired resistance to DS-8201a. We established two XenoSTART Patient-Derived Xenograft (XPDX) models from tissue samples collected two years apart from a patient with ER+/HER2+ breast cancer before and after HER2 directed therapies. These models designated ST4565 and ST4565C were developed and characterized for receptor expression, genomic alterations, and in vivo drug sensitivities toward multiple chemotherapies and targeted agents, including T-DM1 and DS-8201a. Methods: Models ST4565 and ST4565C were established from breast samples collected from a Caucasian female with ER+/HER2+ metastatic breast cancer; ST4565 was collected at age 35 prior to therapy and ST4564C at age 37 following several treatment regimens including 5-FU/doxorubicin/cyclophosphamide, docetaxel/trastuzumab/pertuzumab, and T-DM1/anastrozole. Both were grown subcutaneously in female athymic nude mice supplemented with exogenous estradiol. The resulting models were passaged, and receptor expression confirmed immunohistochemically; genomic analysis, including WES and RNAseq, was performed to further characterize the models. For in vivo studies, both models were evaluated using several chemotherapy and targeted agents alone and in combination including: trastuzumab, pertuzumab, T-DM1, DS-8201a, neratinib, tucatinib, fulvestrant, alpelisib, sacituzumab, and irinotecan. In vivo study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a T/C of ≤ 20% versus control was considered sensitive. Tumor regression (%T/C=< 0) versus Day 0 tumor volume was also reported. Results: ST4565 and ST4565C retained comparable receptor expression (ER=2+/HER2=3+) over tested passages with similar histology compared to archival clinical samples. DNA/RNA sequencing identified several conserved variants including loss of CDKN2A/B and MTAP and a CNV=14 for CCND1. In vivo, ST4565 and ST4565C were found resistant to T-DM1 at 3 mg/kg weekly with a T/C of 100% in both models. However, DS-8201a treatment at 3 mg/kg weekly resulted in partial tumor regressions in ST4565 (T/C=-51%) while ST4565C was found resistant (T/C=49%). Both models were found resistant to all tested chemotherapies and all other targeted therapies but reported similar sensitivity to fulvestrant (T/C=~40%). Conclusion: We established two XPDX models representing T-DM1-resistant, ER+/HER2+ breast cancer from breast samples collected two years apart from the same patient that were found differentially responsive to DS-8201a. These models can be utilized as a valuable tool in better understanding innate resistance to T-DM1 and acquired resistance to DS-8201a. Citation Format: George Plasko, Johnnie Flores, Alyssa Simonson, Peter Forofontov, Ashwin Varma, Amy Lang, Gladys Rodriguez, Kyriakos P. Papadopoulos, Drew Rasco, Amita Patnaik, Bruce Conway, Joe Johnston, Michael Wick. Establishment and characterization of two T-DM1-resistant, ER+/HER2+ breast XPDX models developed sequentially from the same patient with differential in vivo sensitivity to trastuzumab deruxtecan (DS-8201a) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-13-03.

Background: Mechanisms of resistance to CDK4/6 inhibitors (CDK4/6i) have been well studied and several alterations identified including RB loss and altered expression of related genes including CCNE1, E2F4 and CDK6. However, whether duration of clinical treatment might elicit specific mechanism(s) of CDK4/6i resistance is unclear. To better understand if duration of clinical treatment correlates with unique resistance mechanisms, we established, characterized, and compared a panel of ER+ breast XPDX models from patients who benefitted then progressed on a CDK4/6i. Patients were separated into two groups by time to progression (TTP): those who responded up to twelve months (RES12) and patients with clinical response greater than one year (RES13+). Methods: Seventeen breast cancer XPDX models were analyzed, including eight previously described (7xRES12; 1xRES13+: SABCS2021: T Hernandez et al). Nine new models were established from seven patients: six from fluid samples with three designated as ductal (ST3105B, ST3105C, STM001B) and three lobular carcinoma (STM182, STM229, STM229B); two from lymph node biopsies (ST5676, STM127) and one from a liver core biopsy (ST4887B), all reported as ductal carcinoma. STM182 was classified as RES12 and the remaining eight as RES13+. These models were passaged and challenged with CDK4/6i to confirm resistance. Receptor expression was determined by IHC and genomic analyses including WES and RNAseq, were performed to identify mechanisms of resistance. For in vivo studies, CDK4/6i were dosed PO once daily at 50 mg/kg; endpoints included tumor volume (TV) and time from treatment initiation (TTI) with %T/C values and tumor regression reported at study completion; a %T/C of ≤20 versus control was considered sensitive. Tumor regression (%T/C<0) versus Day 0 TV was also reported. Results: Clinical TTP for RES12 (n=8) was four to twelve months and RES13+ (n=9) from thirteen to forty-two months. All models retained ER expression in evaluated passages with similar histology compared with archival clinical samples. Sequencing identified several variants including RB1 truncations or deletions and increased gene expression in CCND1, CCNE1 and the PIK3CA/AKT pathway. Interestingly, 5/8 RES12 models reported ESR1 mutations or fusions versus 1/9 RES13+ and PIK3CA mutations were reported in 1/8 RES12 versus 5/9 RES13+. Several RES13+ models also reported variants and increased amplification in the RICTOR/TORC2 pathway versus RES12. Conclusion: We have established, characterized, and compared a panel of seventeen breast XPDX models from fourteen female patients representing early or late acquired resistance to CDK4/6i therapy and identified potential differences in each set. These models and resulting data are useful in developing novel therapies for CDK4/6i-resistant patients. Citation Format: Alyssa Simonson, Johnnie Flores, Morgan Lynch, Emily Carpenter, Justine Hruzek, Jim Lund, Natalia Baños Herraiz, Kyriakos Papadopoulos, Amy Vander Woude, Gladys Rodriguez, Sreenivasa Chandana, Thomas Gribbin, Nehal Lakhani, Tatiana Hernandez, Maria Jose de Miguel, Amy Lang, Michael J. Wick. Short or long-term treatment with CDK4/6 inhibitors in patients with ER+ breast cancer: characterization and comparative analysis of resistance in seventeen XPDX models. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3869.

Background: Sacituzumab govitecan (SG) is an antibody-drug conjugate targeting Trop2 with an SN-38 payload recently approved for pretreated patients with locally advanced or metastatic triple-negative breast cancer (TNBC). The XenoSTART Patient-Derived Xenograft (XPDX) breast cancer platform includes over 180 models spanning all subtypes characterized with immunohistochemistry (IHC) including ER, PR, and HER2 protein levels, genomic and transcriptomic sequencing, and in vivo drug sensitivity. To better understand potential benefit of SG in breast cancers other than TNBC and further annotate our platform, Trop2 protein levels were determined in all breast models by IHC. We evaluated tumor growth inhibition by SG in 125 of our XPDX breast models and compared protein expression with agent activity. Methods: 180 breast XPDX models were evaluated for Trop2 expression (AF650, R&D Systems) and 125 were evaluated in vivo against SG; responses were grouped by ER and Trop2 status (+/-). Models were grown subcutaneously in female athymic nude mice and ER+ models supplemented with estradiol. Models were also characterized for PR, HER2, and AR protein expression by IHC and profiled using WES and RNAseq. For in vivo studies, SG was administered by intravenous injection biweekly for two cycles at 1 mg, flat; endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a T/C of ≤ 20% versus control was considered sensitive. Tumor regression (%T/C< 0%) versus Day 0 tumor volume was also reported. Results: 180 breast models were examined by IHC with 75/180 (42%) classified as ER+ and 105/180 (58%) ER-. In ER+ models 38/75 (51%) were Trop2+ and 37/75 (49%) Trop2-, and in ER- models 41/105 (39%) were Trop2+ and 64/105 (61%) Trop2-. In vivo, 20% of ER+/Trop2+ models reported sensitivity to SG, most notably models from patients with acquired resistance to CDK4/6 inhibitors, including STM001 and ST4316B. Interestingly, >70% of ER+/HER2+/Trop2+ models were insensitive to SG, including ST225 and ST340. Of 41 ER-/Trop2+ models, approximately 40% reported some response to SG with 50% of these sensitive to therapy, including ST5954 established from a patient who began treatment with SG following sample collection and is currently in remission. >75% of Trop2- models were insensitive to SG regardless of ER status. Conclusion: We screened 180 models in our XPDX breast cancer platform for Trop2 expression and compared expression with in vivo SG efficacy in 125 models. Analysis is underway to correlate receptor and molecular profiles with SG sensitivity in breast models and we are expanding expression and in vivo testing to additional indications. Citation Format: Alyssa Simonson, Johnnie Flores, Ebony Anderson, Crystal Moreno, George Plasko, Kyriakos P. Papadopoulos, Amita Patnaik, Drew Rasco, Gladys Rodriguez, Amy Lang, Muralidhar Beeram, Luis Rodriguez, Ronald Drengler, Steven Abbate, Hanni Salih, Lon Smith, Maryam Elmi, Brittany DeBerry, Arthur Rosenthal, Tatiana Hernandez, Nehal Lakhani, Manish Sharma, Michael Wick. Correlation of Trop2 expression with in vivo sensitivity to sacituzumab govitecan in a panel of breast XPDX models [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-08-05.

Background: Several CDK 4/6 inhibitors have recently been approved in combination with letrozole or fulvestrant in hormone receptor-positive breast cancer. Although this combination therapy has been found effective in some patients, resistance often develops. To aid in developing new therapies for CDK4/6 inhibitor-resistant breast cancer and better understand potential resistance mechanisms, we established a panel of nine XPDX models from eight female patients with luminal A breast cancer at time of progression following acquired resistance to CDK4/6 inhibitor therapy. These models, designated ST940C, ST2056, ST3164B, ST3164B/PBR, ST3932, ST4316B, ST4378, STF160, and STM001B were developed in athymic nude mice and characterized for receptor expression, genomic alterations, and in vivo drug sensitivity. Methods: STF160 was established from a primary biopsy and ST3932 from a metastatic soft tissue lesion; the remaining models were established from malignant fluid samples collected at various stages of treatment post CDK4/6 inhibitor response and progression. The resulting models were passaged and challenged with CDK4/6 inhibitors to confirm resistance and fulvestrant to assess sensitivity. Receptor expression was determined immunohistochemically. Genomic analysis, including WES and RNAseq, were performed to characterize models and identify mechanisms of resistance. For in vivo studies, palbociclib and abemaciclib were dosed by oral administration once daily at 50 mg/kg and fulvestrant by subcutaneous administration once weekly at 2.5 mg. In vivo study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Tumor regression (%T/C<0) versus Day 0 tumor volume was also reported. Results: All models retained ER expression in evaluated passages with similar histology compared with archival clinical samples; HER2 positivity was also confirmed in ST940C which was established from a clinically ER+/HER2+ patient. DNA/RNA sequencing identified several model-specific variants including the ESR1Y537S mutation in ST940C and ST2056 and the ESR1-CCDC170 fusion in ST3164B and ST3164B/PBR; BRCA2Q1089Sfs*10 was identified in ST4316B and PIK3CAE545G in ST4378. In vivo, seven models including ST3164B, ST3164B/PBR, ST3932, ST4316B, ST4378, STF160, and STM001B were found resistant (%T/C>20) to palbociclib or abemaciclib and single agent fulvestrant. ST940C and ST2056 were sensitive (%T/C≤20) to tested CDK4/6 inhibitors but resistant to fulvestrant. Conclusion: We have established and characterized a panel of nine XPDX models from eight female patients with luminal A breast cancer at time of progression following acquired resistance to CDK4/6 inhibitor therapy, seven of which were found resistant to single agent palbociclib and abemaciclib and all nine to fulvestrant. This panel can be utilized as a valuable tool in better understanding CDK4/6 inhibitor resistance and in developing novel therapies for CDK4/6 inhibitor-resistant patients. Citation Format: Tatiana Hernandez, Dustin Kneifel, Alyssa Simonson, Johnnie R Flores, Sarah Quick, April Cabang, Alexandra Ulmer, Kyriakos Papadopoulos, Amy Lang, Gladys Rodriguez, Murali Beeram, Drew Rasco, Amita Patnaik, Scott Ulmer, Michael J Wick. Establishment and characterization of luminal A breast XPDX models from patients with acquired resistance to CDK 4/6 inhibitors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-01-06.

Background: Fulvestrant is a selective estrogen receptor modulator (SERM) approved as a single agent for estrogen receptor positive, HER2 negative breast cancer patients at various stages of disease and in combination with CDK4/6 inhibitors following endocrine therapy failure. Although this agent requires intramuscular injection, it has demonstrated superior activity and fewer side effects versus some oral endocrine treatments however, resistance to fulvestrant often develops. To better understand fulvestrant resistance and its utility in patients who have failed other endocrine therapies, we evaluated the agent in a panel of ER+ breast models established from patients at various stages of disease representing endocrine-sensitive and -resistant disease. Methods: Sixty-five previously developed ER+ breast XPDX models were evaluated in this study. Models were grown subcutaneously in female athymic nude mice supplemented with estradiol in drinking water when necessary. All models were characterized at early and late passages for estrogen receptor expression by immunohistochemistry and profiled using WES and RNAseq. For in vivo studies, fulvestrant was administered by subcutaneous injection at 2.5 or 5 mg per dose once weekly until study completion. In vivo study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Tumor regression (%T/C<0) versus Day 0 tumor volume was also reported. Models were grouped by patient clinical treatment prior to sample collection and model establishment including chemo-naïve, endocrine therapies other than fulvestrant, non-endocrine therapies, and fulvestrant. Results: All models retained ER expression in evaluated passages with similar histology compared with archival clinical samples. DNA/RNA sequencing identified several model-specific variants including ESR1 point mutations and fusions. In this study, 22% of models represented chemo-naïve patients, 24% were from patients treated with non-endocrine therapies, 20% were from patients treated with fulvestrant and the remaining 34% from patients treated with endocrine therapies other than fulvestrant. In vivo, 40% of the chemo-naïve group reported sensitivity to fulvestrant including several models with tumor regressions. Activity of fulvestrant was reported in 25% of models in the non-endocrine therapies group and in 20% of models from patients treated with either fulvestrant or endocrine therapies other than fulvestrant. Several models resistant to fulvestrant from chemo-naïve or patients treated with non-endocrine therapies harbored driver mutations including ESR1, PIK3CA, and AKT1 variants or were HER2+. In models from patients pretreated with fulvestrant, those who had also received a CDK4/6 inhibitor were particularly resistant. Conclusion: We evaluated fulvestrant in a panel of ER+ breast XPDX models representing endocrine-sensitive and -resistant disease from both chemo-naïve and pretreated patients, and identified models responsive and resistant to fulvestrant therapy. This panel can be utilized as a valuable tool in better understanding fulvestrant and endocrine therapy resistance and in developing novel therapies for patients resistant to currently available hormonal therapies. Citation Format: April Cabang, Crystal Moreno, Johnnie R Flores, Jenna Boedeker, Alyssa Simonson, Jun Ma, Amy Lang, Gladys Rodriguez, Arthur Rosenthal, Kyriakos Papadopoulos, Amita Patnaik, Drew Rasco, Lon Smith, Murali Beeram, Ronald Drengler, Luis Rodriguez, Steven Abbate, Scott Ulmer, Michael J Wick. Nonclinical activity of fulvestrant in a panel of ER+ breast XPDX models representing clinically acquired and innate resistance to endocrine therapies [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-01-11.

Background: Trastuzumab deruxtecan (DS-8201a) is an antibody-drug conjugate (ADC) consisting of an anti-HER2 (human epidermal growth factor receptor 2) antibody linked to a topoisomerase I inhibitor payload using a cleavable tetrapeptide-based linker and was recently approved for unresectable or T-DM1-refractory HER2+ breast cancer. While some mechanisms for clinical T-DM1 resistance have been identified, less is known about acquired or innate resistance to DS-8201a. We established two XPDX models of ER+/HER2+ breast cancer from tissue and fluid samples collected simultaneously from the same patient. These models designated ST4480B and ST4480C were developed and characterized for receptor expression, genomic alterations, and in vivo drug sensitivities toward multiple chemotherapies and targeted agents including DS-8201a and T-DM1. Methods: ST4480B and ST4480C were established from a 70-year-old Caucasian female with ER+/HER2+ metastatic breast cancer pretreated with chemotherapy and targeted agents including T-DM1 for nine months followed by capecitabine/trastuzumab/tucatinib combination for one year prior to sample collections. ST4480B was established from a lymph node biopsy and ST4480C from a fluid sample collected the same day; both were grown subcutaneously in female athymic nude mice supplemented with estradiol. The resulting models were passaged and receptor expression confirmed immunohistochemically; genomic analysis, including WES and RNAseq, was performed to further characterize models. For in vivo studies, both models were evaluated with several chemotherapy and targeted agents alone and in combination including: trastuzumab, pertuzumab, T-DM1, DS-8201a, neratinib, tucatinib, alpelisib, everolimus, and irinotecan. In vivo study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Tumor regression (%T/C=—<0) versus Day 0 tumor volume was also reported. Results: ST4480B and ST4480C retained comparable receptor expression (ER=2+/HER2=2+) over tested passages with similar histology compared with archival clinical samples. DNA/RNA sequencing identified several conserved variants including PIK3CAE545K and TP53Q192* mutations and an ESR1-CCDC170 fusion. However, two variants identified only in ST4480C sequences included PIK3CAG1007R and PTENS287L. In vivo, ST4480B and ST4480C were found resistant to T-DM1 up to 10 mg/kg weekly with an average %T/C of 46 and 100, respectively. However, DS-8201a treatment at 3 mg/kg weekly resulted in partial tumor regressions in ST4480B (%T/C=-68) while ST4480C was found resistant to the therapy up to 10 mg/kg weekly (%T/C=84%). Both models were found resistant to trastuzumab, pertuzumab, neratinib, tucatinib, and irinotecan but sensitive to both alpelisib and everolimus. Conclusion: We established two XPDX models representing T-DM1-resistant, ER+/HER2+ breast cancer from both tissue and fluid samples collected simultaneously from the same patient which were found differentially responsive to DS-8201a. These models can be utilized as a valuable tool in better understanding innate resistance to DS-8201a. Citation Format: Johnnie R Flores, Anna Stackpole, Abimael Garza, Alexandra Ulmer, Alyssa Simonson, Kyriakos Papadopoulos, April Cabang, Jun Ma, Amita Patnaik, Drew Rasco, Amy Lang, Gladys Rodriguez, Murali Beeram, Michael J Wick. Establishment and characterization of two simultaneously developed T-DM1-resistant, ER+/HER2+ XPDX models from the same patient with differential in vivo sensitivity to trastuzumab deruxtecan (DS-8201a) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-01-09.

CDK 4/6 inhibitors have been recently approved in combination with letrozole in hormone receptor-positive breast cancer. Although this combination therapy has been found effective in some patients, resistance often develops. To aid in developing new therapies for palbociclib-resistant breast cancer and better understand resistance mechanisms, we established two PDX models from patients with luminal A breast cancer at time of progression, following acquired resistance to palbociclib therapy. Two models, designated ST3932 and ST4378, were developed in athymic nude mice and characterized for receptor expression, genomic alterations, and in vivo drug sensitivity. ST3932 was established from a biopsy taken from a 62-year-old woman pretreated with various therapies including tamoxifen, fulvestrant/palbociclib, and paclitaxel. ST4378 was established from fluid taken from a 66-year-old woman pretreated with various therapies including letrozole/radiation, docetaxel/cyclophosphamide, and letrozole/palbociclib. The resulting models were passaged and challenged with palbociclib and other CDK4/6i to confirm resistance. Receptor expression was determined immunohistochemically. Genomic analysis, including WES and RNAseq, were performed to characterize models and identify mechanisms of resistance. For in vivo studies, endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion. The ST3932 and ST4378 models retained ER expression over tested passages with similar histology compared with an archival clinical sample. Sequencing identified several conserved variants; however, none have been currently identified as known mechanisms for palbociclib resistance. Both models demonstrated resistance to palbociclib with %T/C values >90%; however, ST3932 reported moderate sensitivity to both ribociclib and abemaciclib (%T/C∼50%). We have established and characterized two palbociclib-resistant breast PDX models, designated ST3932 and ST4378, which can be utilized as a valuable tool in better understanding CDK4/6i resistance and in developing novel therapies for CDK4/6i-resistant patients.

Background: 15-20% of metastatic breast cancers are characterized by overexpression or amplification of human epidermal growth factor receptor 2 (HER2). First-line treatment for HER2-positive metastatic breast cancer includes the anti-HER2 monoclonal antibodies trastuzumab and pertuzumab in combination with chemotherapy. Second-line therapy includes T-DM1, an antibody-drug conjugate (ADC) consisting of trastuzumab conjugated to maytansinoid (DM1). Until recently, patients who progress on T-DM1 were left with few treatment options. Trastuzumab deruxtecan (DS-8201a) is an antibody-drug conjugate (ADC) consisting of an anti-HER2 (human epidermal growth factor receptor 2) antibody linked to a novel topoisomerase I inhibitor payload using a cleavable tetrapeptide-based linker and was recently approved for unresectable or T-DM1-refractory HER2+ breast cancer. In addition, DS-8201a is currently being evaluated as a treatment in breast cancers with low and medium expression of HER2. To better understand the potential for DS-8201a as a treatment in these cancer types, we evaluated this therapy in a panel of ER+/- XPDX models with differential HER2 expression. In addition, we compared DS-8201a activity to T-DM1 and benchmarked efficacy of the topoisomerase I inhibitor irinotecan in all tested models. Methods: One hundred (50ER+/50ER-) breast XPDX models were evaluated in this study. Models were established and characterized for estrogen receptor and HER2 expression by IHC and profiled using WES and RNAseq. For in vivo studies, DS-8201a and T-DM1 were administered IV at 3 mg/kg and irinotecan IP at 100 mg/kg on a weeklyx3 schedule. In vivo study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Results: Models were grouped by ER positivity (+/-) and model HER2 score and designated as null (0), low (1+), medium (2+) or high (3+); models established from clinically HER2+ patients were also noted. In the ER+ group, HER2 low and medium expressing models accounted for over 80% of the total, while 15% were categorized as high and less than 5% as null. All models with high and 30% with medium HER2 staining were from clinically HER2+ patients, no low or null models were established from breast cancer assigned HER2+ clinically. In the ER- group, HER2 low and medium expressing models accounted for 75% of the total, while 12% were categorized as high and 13% as null. All models with high and 13% with medium HER2 staining were from clinically HER2+ patients; 5% of low or null models were established from breast cancer assigned HER2+ clinically. In vivo, 65% of the ER+ group reported sensitivity to DS-8201a versus 25% to T-DM1; 10% of DS-8201a, and 40% of T-DM1 sensitive models were high expression models and the remaining low and medium with no null models reporting sensitivity to either agent. 35% of tested ER+ models were sensitive to both HER2 therapies and 50% of models sensitive to DS-8201a were also sensitive to irinotecan. In the ER- group, 70% reported sensitivity to DS-8201a versus 25% to T-DM1; 20% of DS-8201a and 25% of T-DM1 sensitive models were high expression models and the remaining low and medium with one null model (ST069) sensitive to both agents. 25% of tested ER- models were sensitive to both HER2 therapies and 40% of models sensitive to DS-8201a were also sensitive to irinotecan. Conclusion: We have compared activity of DS-8201a, T-DM1 and irinotecan in a panel of ER+/- XPDX models and correlated activity based on HER2 expression. This data and panel can be utilized as a valuable tool in better understanding the potential for DS-8201a and other HER2-targeting therapies as a treatment in cancers driven by HER2 expression. Citation Format: Alyssa Simonson, Peter Forofontov, Johnnie R Flores, Kimberly Hernandez, April Cabang, Amy Lang, Gladys Rodriguez, Kyriakos Papadopoulos, Murali Beeram, Arthur Rosenthal, Brittany DeBerry, Lon Smith, Ronald Drengler, Amita Patnaik, Drew Rasco, Luis Rodriguez, Steven Abbate, Scott Ulmer, Michael Wick. Correlation of HER2 receptor expression and in vivo activity of the HER2-targeting therapies trastuzumab deruxtecan (DS-8201a) and T-DM1 activity in a panel of breast XPDX models [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-01-04.

Background: First-line treatment for some cancer types includes platinum-based therapy. While the rate of initial response to treatment is high, most patients develop platinum-resistant disease. Current salvage therapy provides benefit to some patients, demonstrating the need for additional effective therapies. To assist in identifying new therapies, we have established XenoSTART patient-derived xenograft (XPDX) models representing breast, ovary, uterine, and lung cancers. Each model was characterized by DNA/RNA analysis, sensitivity to platinum treatment, and annotated with donor patient treatment status at the time of sample collection. Methods: 210 XPDX models were evaluated in this screen including 66 breast, 56 ovary, 36 uterine, and 52 lung xenografts. WES and RNAseq were performed on each model and patient treatment history and outcome annotated. For in vivo studies, models were implanted into female nudes and administered (IP; q7dx3) 3 m/k cisplatin or 60 m/k carboplatin. Study endpoints included tumor volume and time from treatment initiation with %T/C values and tumor regression reported at study completion; a %T/C of ≤ 20 versus control was considered sensitive. Results: Study results are summarized below in Table 1: Sequencing identified several variants in resistant, chemo-naïve models including point mutations in RAS/RAF/MET/PIK3CA genes and others, while sensitive models lacked common driver mutations. Conclusion: We have characterized 210 XPDX models. Uterine models were most often resistant to platinum, while almost 1/2 of ovary and 1/3 of breast models were sensitive, regardless of treatment status. Only 15% of lung models were sensitive to platinum; cancer driver variants were found in several models. Overall, we report differential platinum sensitivity in a panel of diverse models useful in understanding mechanisms of resistance and for development of effective therapies in platinum-resistant cancers. Table 1. Type Breast Ovary Uterine Lung Total 66 56 36 52 # Sensitive 25 25 9 8 % 38% 45% 25% 15% Naïve 11 16 8 5 % 44% 64% 89% 63% P-1st 6 6 1 2 % 24% 24% 11% 25% P-2nd+ 6 3 0 1 % 24% 12% 0% 13% # Insensitive 41 31 27 44 % 62% 55% 75% 85% Naïve 11 9 20 21 % 27% 29% 74% 48% P-1st 14 10 5 13 % 34% 32% 19% 30% P-2nd+ 16 12 2 10 % 39% 39% 7% 23% Naïve=No Prior Treatment; P-1st=Post 1st Line Therapy; P-2nd=Post 2nd+ Line Therapy Citation Format: Alyssa Simonson, Johnnie Flores, Lizette Firova, Christian Hernandez, Morgan Harris, Kyriakos Papadopoulos, Drew Rasco, Amita Patnaik, Allan White, Lon Smith, Ronald Drengler, Amy Lang, Murali Beeram, Michael J. Wick. Correlation of platinum sensitivity with donor patient treatment status in a panel of breast, ovary, uterine, and lung XPDX models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1092.