GSE201740
Sunitinib efficacy with minimal toxicity in patient-derived organoid models of retinoblastoma
Background. Recurrence or persistence of retinoblastoma (RB) is common following chemoreduction and often be managed with intra-arterial/ intravitreal chemotherapy. However, no/minimal response to local chemotherapy has been documented, with enucleation needed for tumor control. Otherwise, the globe is preserved with effective tumor control but at the cost of vision due to retinal toxicity. The aim of this study was to discover novel drug with improved antitumor activity and retinal safety profiles for RB via drug reprofiling in patient-derived tumor organoids.  Methods. Five tumor organoid lines were fully characterized using CGH/SNP array and whole exome sequencing and used as a model to test 133 FDA-approved compounds using two-step screening processes. RNA sequencing was conducted to generate drug signature in conjunction with cell cycle and apoptotic assays. An ability of candidate drug to restrict proliferative tumor cone were examined together with retinal toxicity testing in human ESC-derived retinal organoids, in comparison with clinically used drugs by immunostaining.  Results. Sunitinib was identified as high cytotoxic agent for the classical RB1-deficient and novel MYCN-amplified RBs. Gene signature indicated that anti-tumoral activity of sunitinib was associated with MAPK activity. Additionally, sunitinib was more effective to suppress proliferative tumor cones and had less retinal toxicity compared with melphalan and topotecan.   Conclusions. Sunitinib may be a “universal” drug for all subtypes of RB. With high efficacy and low retinal toxicity, sunitinib is potential agent used in local chemotherapy for treating RB. Overall design: Duplicate samples each of two different suptypes of retinoblastoma cells were treated with sunitinib. Duplicate samples without sunitib treatment serve as a control.