Abstract 2499: Window-of-opportunity trial of metastatic pancreatic cancer reveals potential mechanisms of response to targeting RAS signaling

Abstract KRAS is mutated in ~85% of pancreatic ductal adenocarcinoma (PDAC) patient's tumors, suggesting that it is a key node of PDAC targeted therapy. RAF/MEK/ERK signaling is downstream of KRAS signaling. Preclinical studies targeting MEK showed promises but clinical trials failed to show the benefit compared to Standard-of-Care treatment chemotherapy. To elucidate the mechanism of action and resistance to several targeted therapies including MEK inhibition in human PDAC, we conducted a Window-Of-Opportunity trial for Metastatic pancreatic cancer (WOOM trial). In this trial, metastatic PDAC patients received 10 days of Cobimetinib, a FDA approved MEK inhibitor, therapy and specimens of pre- and post- treatment were obtained by biopsy to evaluate the response to targeted treatment using deep multi-omic analytics including DNA-seq, RNA-seq, multiplex IHC, cyclic IF and Digital Spatial Profiling (DSP). The clinical grade KI67 staining positivity was used as a readout of tumor response. We found three of 15 patient’s tumors had significantly decreased KI67 staining positivity after Cobimetinib treatment and defined them as Responsive tumors. Genomic sequence showed that KRAS allelic imbalance and KrasG12R mutations were seen significantly higher frequency in Responsive tumors compared to Non-responsive tumors. RNA-seq analysis showed that these Responsive tumors were more likely to be classical-like subtype compared to Non-responsive tumors. DSP analysis confirmed the downregulation of ERK phosphorylation after treatment in all examined cases consistent with effective target inhibition. Interestingly, MEK phosphorylation was upregulated after treatment paradoxically. This suggests that paradoxical upstream pathway activation including RAF activation could be potential resistance mechanism. MYC protein expression change was significantly correlated with KI67 protein expression change, which suggests MYC downregulation could contribute to action of Cobimetinib. We also found that Cobimetinib treatment increased the immunosuppressive TREM2+ Macrophage population from single cell RNA-seq data. Furthermore, PDX from biopsy recapitulated patient's response to therapy and could be a great tool for testing new therapeutic strategies. Here, we summarize the multi-omics data and discuss potential mechanisms of response and resistance to targeting RAS signaling and related microenvironmental changes. Citation Format: Motoyuki Tsuda, Colin Daniel, Xiaoyan Wang, Carl Pelz, Hayley Zimny, Alexander Smith, John Muschler, Xi Li, Tugba Yildiran Ozmen, Furkan Ozmen, Dove Keith, Christopher Corless, Koei Chin, Jonathan Brody, Charles Lopez, Gordon Mills, Rosalie Sears. Window-of-opportunity trial of metastatic pancreatic cancer reveals potential mechanisms of response to targeting RAS signaling abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 2499.