High-Throughput Screening Of Glioma Stem-Like Cells (Gscs) Identifies Synergistic Therapeutic Combination Of Fgfr Inhibitor And Cdk4/6 Inhibitor

High-grade gliomas are challenging tumors to treat. The lack of efficacy of single-agent therapy emphasizes the importance of developing combination strategies to overcome acquired resistance. Quantitative high-throughput screening (HTS) of 2 and 3 drug combinations at 5 concentrations (maximal concentration of 1 uM) of each agent were evaluated in a panel of GSCs to identify potentially novel combination therapy. Genomic, proteiomic (reverse protein lysate array, RPPA) and GSC subtype were correlated with drug IC50 to find biomarkers of drug sensitivity. GSCs were classified as sensitive (IC50 ≤ 1µM) or resistant (IC50 >1µM) for single-agent screening. The Bliss independence model and combination index (CI) criteria were used to quantify the synergy of compound combinations. Evaluation of drug combination data for synergistic combination identified FGFR inhibitor LY2874455 and CDK4/6 inhibitor LY2835219 as the most effective combinations for multiple drug sets. Abnormal activation of FGFR and alterations in the CDKN2A-CDK4/6-Retinoblastoma 1 (RB1) pathway have been implicated in glioblastoma pathogenesis. We further investigated the in vitro combination efficacy of FGFR inhibitor and CDK4/6 inhibitor. Compared to single agent, combination of FGFR inhibitor and CDK4/6 inhibitor induced prominent cleaved poly ADP ribose polymerase (c-PARP), an index of apoptosis, which was further confirmed by Annexin V staining. Combination therapy significantly inhibited p-RB, p-STAT3, p-Akt, p-Erk and p-c-Jun expression compared to single agent. Genomic data demonstrated that high PDGFRα expression and low methylation correlated to sensitivity to the FGFR and CDK4/6 inhibitor combination. These findings were validated by demonstrating that this synergistic sensitivity was decreased by knocking out PDGFRα by CRISP/Cas9 system with the combination index (CI) at IC50 increased from 0.964 to 2.247. In addition, Western blotting showed that expression of PDGFRα and Notch1 was significantly inhibited by combination treatment. However, this combination failed to show any survival and tumor inhibition benefits in intracranial xenograft mouse models. Citation Format: Jianwen Dong, Emmanuel Martinez-Ledesma, Nghi Nguyen, Shaofang Wu, Yuji Piao, Ningyi Tiao, Soon Young Park, David Brunell, Clifford Stephan, Roel Verhaak, Erik Sulman, Veerakumar Balasubramaniyan, John F. de Groot. High-throughput screening of glioma stem-like cells (GSCs) identifies synergistic therapeutic combination of FGFR inhibitor and CDK4/6 inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4819.