Oncology
Abstract
BACKGROUND. Current diagnosis and surveillance of bladder cancer relies on cystoscopy which is invasive and user dependent. The urine mRNA panel, uRNAp, measures expression of 3 genes for identification of bladder cancer. Here we report validation of uRNAp for patients undergoing initial work-up for suspected bladder cancer and surveillance for bladder cancer. METHODS. Urine specimens were prospectively collected prior to cystoscopy at two health care systems from patients without (detection cohort) or with (surveillance cohort) a history of bladder cancer. RNA was isolated from urine sediment for RT-qPCR to determine ROBO1, CRH, and IGF2 expression and calculate the uRNAp bladder cancer probability score. RESULTS. In the detection cohort, 547 samples were collected from 529 patients. There were 123 new diagnoses of bladder cancer in the detection cohort and uRNAp demonstrated 98% sensitivity and 51% specificity for identification of bladder cancer. In the surveillance cohort, 1543 samples were collected from 447 patients with 286 recurrences. uRNAp demonstrated 94% overall sensitivity with 43% specificity and 99% sensitivity for high-grade recurrence. The receiver operating characteristic area under the curve was 0.92 in the detection and 0.81 in the surveillance cohort. uRNAp scores significantly increased with tumor size and grade. CONCLUSIONS. Prospective validation of uRNAp demonstrated a strong potential clinical utility as a non-invasive adjunct to cystoscopy for management of bladder cancer. uRNAp may be a useful triage tool to defer or expedite cystoscopy for patients undergoing detection or surveillance of bladder cancer. FUNDING. Department of Veterans Affairs BLR&D Merit Review I01 BX004962 to JCL.
Authors
Kathleen E. Mach, Zachary Kornberg, Eugene Shkolyar, Jin Long, Timothy J. Lee, Vinh La, Ihna Yoo, Gabriela Rodriguez, Alan E. Thong, Kris B. Prado, Jay B. Shah, John T. Leppert, Eila C. Skinner, Joseph C. Liao
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) remains lethal with limited treatment options. Antibody–drug conjugates (ADCs) have emerged as a transformative class across multiple solid tumors, yet their clinical application in prostate cancer has been limited. Izalontamab brengitecan (Iza-bren; BL-B01D1) is a bispecific ADC targeting EGFR and HER3 that has demonstrated activity in other malignancies. Here, we evaluated its therapeutic potential in prostate cancer. Multi-omics analyses revealed frequent EGFR and HER3 expression in CRPC adenocarcinoma but not in neuroendocrine subtypes. BL-B01D1 exerted potent, target-dependent cytotoxicity in prostate cancer cell lines, xenografts, and patient-derived organoids (PDOs). We highlight a representative mCRPC patient with high EGFR/HER3 expression who achieved a rapid and durable clinical and radiologic response to BL-B01D1, concordant with matched PDO sensitivity. Mechanistic studies identified ABCG2 upregulation as a driver of acquired resistance, with genetic or pharmacologic inhibition restoring BL-B01D1 sensitivity. Importantly, tumor tissue obtained at progression after BL-B01D1 treatment confirmed ABCG2 upregulation, validating a clinically relevant resistance mechanism. These findings support BL-B01D1 as a promising therapeutic strategy in mCRPC and nominate ABCG2 as a rational target for overcoming resistance.
Authors
Bangwei Fang, Xiaomeng Li, Ying Lu, Weiwei Ma, Hualei Gan, Tingwei Zhang, Qi Liu, Beihe Wang, Zixian Wang, Yi Zhu, Hai Zhu, Sa Xiao, Xiaojie Bian, Gonghong Wei, Dingwei Ye, Yao Zhu
Abstract
Immunotherapies achieve durable responses in several cancers but show limited efficacy in refractory hepatocellular carcinoma (HCC). The mechanisms by which hepatoma cells evade immune recognition and limit immune checkpoint blockade (ICB) efficacy are incompletely defined. Here, we identified tumor-intrinsic tescalcin (TESC) as a previously unrecognized phagocytic checkpoint that contributes to immune evasion and ICB resistance in HCC. Mechanistically, H3K4 methylation drove TESC expression in hepatoma cells, facilitating cytosolic Ca²⁺ buffering and attenuating endoplasmic reticulum (ER) stress-induced calreticulin (CALR) plasma membrane exposure, an essential “eat-me” signal. Consequently, this process abrogates membrane CALR-directed phagocytosis by antigen-presenting cells (APCs), including macrophages and dendritic cells, thereby impairing antigen presentation and subsequent T-cell activation. Clinically, elevated H3K4me3-TESC signaling was a promising prognostic biomarker for poor ICB response of HCC. Importantly, in vivo disruption of this axis restored APC phagocytic function and enhanced the antitumor effects of ICB therapy. Thus, targeting TESC-driven immune escape and its underlying epigenetic regulation may restore APC function and offer a precise therapeutic strategy to enhance immunotherapy efficacy in HCC.
Authors
Jiong-Liang Wang, Jun-Cheng Wang, Yangxun Pan, Minrui He, Zhikai Zheng, Hao Zou, Tianqing Wu, Yuhan Zhang, Zili Hu, Yizhen Fu, Wei Peng, Zhenyun Yang, Li Xu, Yao-Jun Zhang, Min-Shan Chen, Dandan Hu, Jinbin Chen, Ming Zhao, Dong-Ping Chen, Zhong-Guo Zhou
Splicing factor TRA2B enhances synthesis of androgen receptor variant AR-V7 in prostate cancer cells
Abstract
Treatment of locally advanced and metastatic prostate cancer (PC) with androgen receptor–targeting (AR-targeting) therapies has limited durability, with disease eventually progressing to castrate-resistant PC (CRPC). Constitutively active AR splice variants (AR-Vs), such as AR-V7, play a key role in driving treatment resistance and disease progression. Importantly, the failure to attenuate AR-V function represents a major unmet clinical need, and as such, defining how AR-Vs are generated is likely to yield new therapeutic targets. Our knowledge of factors that mediate splicing of AR-V–encoding mRNAs remains limited. Here, we have employed an RNA-targeting CasRx approach to identify selective protein interactors of AR-V7 mRNA in PC. TRA2B and its ortholog, TRA2A, were identified as splicing regulators of AR transcripts that facilitate AR-V synthesis at the expense of full-length AR isoforms. TRA2B expression correlated with AR-V7 transcript in CRPC and attenuation of TRA2-mediated splicing diminished PC cell growth. Exploiting TRA2B function may therefore provide new therapeutic opportunities in advanced disease.
Authors
Nicholas Brittain, Alec Paschalis, Ryan Nelson, Beth Adamson, Laura Walker, Ruaridh Duncan, Graham R. Smith, Suzanne McGill, Richard J.S. Burchmore, Denisa Bogdan, Juan M. Jiménez-Vacas, Jonathan Welti, Wei Yuan, Craig N. Robson, Pasquale Rescigno, Sara Luzzi, Adam Sharp, Johann de Bono, Luke Gaughan
Abstract
New androgen receptor (AR) pathway inhibitors (ARPIs) in clinical development, including AR degraders and CYP11A inhibitors, largely target ligand-dependent AR activation and have reported antitumor activity in metastatic castration-resistant prostate cancer (mCRPC) resistant to established ARPIs, predominately against tumors with AR mutations. We hypothesized that AR-mutated mCRPC exhibits lower AR splice variant 7 (AR-V7) expression and remains full-length–AR (FL-AR) driven, explaining, in part, the antitumor activity of these AR ligand–binding domain (LBD) targeting drugs. The data herein demonstrate that mCRPC tissue biopsies with detectable AR mutations express significantly lower levels of AR-V7 protein and associate with better overall survival and enhanced sensitivity to ARPIs. This is independent of differences in the total number of global splicing events but may be related to differences in splicing factor expression between AR-mutated and nonmutated mCRPC. In conclusion, AR-mutated mCRPC frequently exhibits low AR-V7 expression, arguably explaining the enhanced sensitivity to ARPIs observed in these cancers. Consequently, AR mutation status may serve as a biomarker to predict response to AR-directed therapies.
Authors
Alec Paschalis, Ines Figueiredo, Denisa Bogdan, Arian Lundberg, Rita Santos, Bora Gurel, Tarek Taha, Ossian Longoria, Ana Ferreira, Claudia Bertan, Nicholas Brittain, Ryan Nelson, Laura Walker, Antje Neeb, Jonathan Welti, Wei Yuan, Costas Mitsopoulos, Stephen R. Plymate, Michael C. Haffner, Adam G. Sowalsky, Suzanne Carreira, Adam Sharp, Luke Gaughan, Johann de Bono
Abstract
BACKGROUND Proliferation is a key biological feature of cancer and in prostate cancer is modulated by androgen receptor (AR) signalling. Cohort studies have suggested that highly proliferative tumors respond poorly to androgen receptor pathway inhibitors (ARPIs). To clarify whether tumor proliferation interacts with treatment benefit from adding abiraterone to androgen deprivation therapy (ADT), we assessed the Ki-67 proliferation index in prostate core biopsies from participants enrolled in the STAMPEDE platform protocol. METHODS Proliferation was assessed by Ki67 immunohistochemistry on tumors from patients randomized in two sequential but non-overlapping (ie no shared controls) phase 3 trials of abiraterone or abiraterone and enzalutamide conducted in STAMPEDE (NCT00268476), with 14-year survival outcomes. A standardised unweighted global assessment method was used. Survival analyses used Cox proportional hazards models adjusted for established prognostic factors. Ki-67 was examined both continuously and dichotomised at the median. Sensitivity analyses excluded samples exposed to ADT. RESULTS Ki-67 was successfully scored on cancers from 1,605 patients. Higher Ki-67 was strongly prognostic for shorter overall survival across disease states. However, in metastatic patients treated with ADT plus abiraterone, the adverse prognostic impact of high Ki-67 was substantially attenuated (aHR=1.06 per 10-percentage-point increase), with a statistically-significant treatment-biomarker interaction (p<0.001) confirming highly proliferative tumors derived greater treatment benefit. No interaction was observed in non-metastatic disease. CONCLUSION Ki-67 is an independent prognostic biomarker in advanced prostate cancer. In metastatic disease, higher proliferation predicts greater sensitivity to abiraterone added to ADT, suggesting a potential biological vulnerability of rapidly cycling tumors to intensified AR pathway blockade. TRIAL REGISTRATION: NCT00268476
Authors
Larissa Mendes, Peter F. Dutey-Magni, Emily Grist, Ashwin Sachdeva, Sara Santos Vidal, Sharanpreet Lall, Marina A. Parry, Claire L. Amos, Nafisah B. Atako, Anna Wingate, Daniel Wetterskog, Matthew R. Sydes, Chris C. Parker, Noel Clarke, Christopher J. Sweeney, Mahesh KB Parmar, Louise C. Brown, Nicholas D. James, Daniel M. Berney, Gerhardt Attard
Abstract
Epigenetic dysregulation is associated with immune evasion and immune checkpoint blockade (ICB) resistance. Here, using in vivo CRISPR-Cas9 screens targeting epigenetic-related factors in mouse tumor models treated with ICB, we identified Chromobox 4 (CBX4) as a key negative regulator of immune tumor microenvironment. Single-cell RNA sequencing and spatial transcriptomics analyses of patients receiving neoadjuvant anti-PD-1 therapy revealed high CBX4 expression in both tumor cells and immunosuppressive tumor-associated macrophage subpopulations, with preferential accumulation in non-responders. Deficiency of CBX4 in macrophages or tumor cells, induced robust anti-tumor immunity, increased infiltration and cytotoxic activity of CD8+ T cells and NK cells, thereby heightening the sensitivity of ICB treatment. Mechanistically, CBX4 targeted H3K9me3 and H3K27me3-marked endogenous retroelements such as RLTR4-Mm-int. Loss of CBX4 derepressed retrotransposons, activating cytosolic RNA-sensing pathways and triggering type I interferon response, ultimately leading to robust inflamed TME. Moreover, we uncovered a negative correlation between CBX4 expression and immune responses, retrotransposon levels as well as the prognosis of patients with hepatocellular carcinoma (HCC) undergoing ICB therapy. Our study establishes CBX4 as an epigenetic immune checkpoint through the epigenetic silencing of retrotransposons, remodeling immune TME and thus providing a promising therapeutic target to enhance tumor immunogenicity and overcoming immunotherapy resistance.
Authors
Zhibo Ma, Wenlong Jia, Xi Zhou, Jing Liu, Qingwen Li, Ruizhi Chang, Shiqi Gu, Naonao Yuan, Zhishui Chen, Peixiang Lan
Abstract
Resistance to HIF-2α inhibitors such as Belzutifan underscores the need to better understand how HIF-2α is transcriptionally regulated in clear cell renal cell carcinoma (ccRCC). Here, we uncover a cytokine-driven enhancer mechanism that sustains HIF-2α expression through the JAK1–STAT3 signaling pathway. Using a genome-wide CRISPR screen in VHL-deficient ccRCC cells, we identified SOCS3 as a key negative regulator of HIF-2α. Mechanistically, loss of SOCS3 activates JAK1–STAT3 signaling, leading to the recruitment of STAT3 to distal enhancers upstream of EPAS1 that physically loop to its promoter to drive HIF-2α transcription. This cytokine–enhancer circuit was recapitulated in ccRCC patient samples and functionally validated using CRISPR interference, which disrupted enhancer–promoter looping and reduced tumor growth in HIF-2α–dependent models. SOCS3 overexpression or pharmacologic inhibition of JAK1/STAT3 markedly suppressed HIF-2α expression and tumor progression both in vitro and in vivo. Unlike prior studies focusing on VHL/HIF occupancy–driven enhancer activation, this work defines a trans-acting cytokine–JAK1–STAT3 pathway that transcriptionally controls EPAS1. Together, these findings reveal a targetable enhancer mechanism that sustains HIF-2α expression and suggest that combined inhibition of JAK1/STAT3 and HIF-2α may overcome therapeutic resistance in kidney cancer.
Authors
Jun Fang, Jeremy M Simon, Tao Wang, Yunpeng Gao, Xianju Bi, Lianxin Hu, Chengheng Liao, Cheng Zhang, Yayoi Adachi, Jin Zhou, Hongyi Liu, Qian Liang, James A. Nathan, Ram Mani, James Brugarolas, Qing Zhang
Abstract
Single-agent anti-PD-1 antibody is ineffective for pancreatic ductal adenocarcinoma (PDAC) due to its immunosuppressive tumor-microenvironment (TME). KRAS-mutations contribute to the inflammatory TME and therapeutic resistance by upregulating IL-8 via MAPK pathways. Thus, this study attempted to overcome the resistance to anti-PD-1 antibody by targeting downstream KRAS-effectors. The study found that the resistance to anti-PD-1 antibody can be overcome through MEK1/2-inhibition. The combination of anti-PD-1 antibody and MEK inhibitor displayed antitumor activity in Krasmut (mutated) KPC mouse tumors, but not KrasWT (wild-type) Panc02 tumors. The combination of anti-PD-1 antibody and MEK inhibitor induced recruitment of tumor-associated neutrophils (TANs) via CXCR2, an IL-8 receptor, and increased memory CD8+ T cells and IFNgamma production in treatment-sensitive tumors. However, larger tumors still resisted to the combination of anti-PD-1 antibody and MEK inhibitor likely due to hypoxia/necrosis-induced NETosis and associated paucity of CD8+ T cells. The subsequent addition of anti-CXCR2 antibody overcame this resistance by blocking TAN-infiltration to hypoxic/necrotic areas. Consistently, a risk-score based on the NETosis-MAPK signaling interaction is significantly associated with poorer survival in human PDACs. This study thus provides a new venue for overcoming resistance to strategies targeting KRAS signaling.
Authors
Brian Herbst, Alex B. Blair, Yiming Li, Elizabeth M. Jaffee, Lei Zheng
Abstract
Glioblastoma (GBM) is a highly aggressive brain tumor characterized by extensive crosstalk between glioblastoma stem cells (GSCs) and immunosuppressive microglia, with our previous work identifying CLOCK and TFPI2 as key regulators of this interaction. Here, we uncover a ‘symbiotic exclusivity’ pattern between CLOCK and TFPI2, showing that despite mutually exclusive amplifications, they sustain symbiotic regulatory interactions in GBM. The CLOCK-BMAL1 complex transcriptionally upregulates TFPI2, while TFPI2-driven hypoxia inducible factor 1 alpha (HIF1a) signaling activates nuclear factor kappa B (NF-kB) P65 to upregulate the CLOCK-BMAL1 complex, creating a positive feedback loop to promote stemness, immunosuppression, and tumor progression. Disrupting the CLOCK-TFPI2 interplay through dual inhibition of their downstream effectors reduces GSC stemness and immunosuppressive microglia, activates antitumor immunity, and synergizes with anti-PD1 therapy to achieve complete tumor regression in 50-62.5% of tumor-bearing mice. This study uncovers a promising therapeutic strategy for a broader subset of GBM patients with high expression of either CLOCK or TFPI2, and provides a framework for identifying 'symbiotic exclusivity' genes in cancer.
Authors
Fei Zhou, Lizhi Pang, Yang Liu, Fatima Khan, Peiwen Chen
Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)