title: PI3K/mTOR dual inhibitor VS-5584 preferentially targets cancer stem cells.
abstract: Cancer stem cells (CSC) have been implicated in disease recurrence, metastasis, and therapeutic resistance, but effective targeting strategies for these cells are still wanting. VS-5584 is a potent and selective dual inhibitor of mTORC1/2 and class I PI 3-kinases. Here, we report that VS-5584 is up to 30-fold more potent in inhibiting the proliferation and survival of CSC compared with non-CSC in solid tumor cell populations. VS-5584 preferentially diminished CSC levels in multiple mouse xenograft models of human cancer, as evidenced by marked reduction of tumor-initiating capacity in limiting dilution assays. Likewise, VS-5584 treatment ex vivo preferentially reduced CSC in surgically resected breast and ovarian patient tumors. In contrast, chemotherapeutics such as paclitaxel and cisplatin were less effective in targeting CSC than bulk tumor cells. Mechanistic investigations revealed that preferential targeting of CSC required inhibition of multiple components of the PI3K-mTOR pathway: coordinate RNAi-mediated silencing of PI3Kα, PI3Kβ, and mTOR phenocopied the effect of VS-5584, exhibiting the strongest preferential targeting of CSC, while silencing of individual PI3K isoforms or mTOR failed to replicate the effect of VS-5584. Consistent with CSC ablation, VS-5584 delayed tumor regrowth following chemotherapy in xenograft models of small-cell lung cancer. Taken together, the preferential targeting of CSC prompts a new paradigm for clinical testing of VS-5584: clinical trials designed with CSC-directed endpoints may facilitate demonstration of the therapeutic benefit of VS-5584. We suggest that combining VS-5584 with classic chemotherapy that debulks tumors may engender a more effective strategy to achieve durable remissions in patients with cancer.
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Vihren N
authors.initials: VN
authors.lastname: Kolev
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Quentin G
authors.initials: QG
authors.lastname: Wright
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Vidal
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ring
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Irina M
authors.initials: IM
authors.lastname: Shapiro
authors.affiliation: Molecular Response, San Diego, California.
authors.forename: Jill
authors.initials: J
authors.lastname: Ricono
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: David T
authors.initials: DT
authors.lastname: Weaver
authors.affiliation: Verastem Inc., Needham, Massachusetts.
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Padval
authors.affiliation: Verastem Inc., Needham, Massachusetts. jpachter@verastem.com qxu@verastem.com.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Pachter
authors.affiliation: Verastem Inc., Needham, Massachusetts. jpachter@verastem.com qxu@verastem.com.
authors.forename: Qunli
authors.initials: Q
authors.lastname: Xu
mesh_terms: D000818:Animals; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D005260:Female; D006801:Humans; D061986:MCF-7 Cells; D051379:Mice; D016688:Mice, Inbred NOD; D016513:Mice, SCID; D009025:Morpholines / Q000494:pharmacology*; D014411:Neoplastic Stem Cells / Q000187:drug effects* / Q000201:enzymology*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D019869:Phosphatidylinositol 3-Kinases / Q000378:metabolism; D000081082:Phosphoinositide-3 Kinase Inhibitors; D047428:Protein Kinase Inhibitors / Q000494:pharmacology*; D011687:Purines / Q000494:pharmacology*; D011897:Random Allocation; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D023041:Xenograft Model Antitumor Assays
chemical_list: D009025:Morpholines; D019869:Phosphatidylinositol 3-Kinases; D000081082:Phosphoinositide-3 Kinase Inhibitors; D047428:Protein Kinase Inhibitors; D011687:Purines; D058570:TOR Serine-Threonine Kinases; C585120:VS-5584; C546842:MTOR protein, human