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Translation of DNA Damage Response Inhibitors as Chemoradiation Sensitizers From the Laboratory to the Clinic

Leslie A. Parsels, Qiang Zhang, David Karnak, Joshua D. Parsels, Kwok Lam, Henning Willers, Michael D. Green, Alnawaz Rehemtulla, Theodore S. Lawrence,

Abstract: Combination therapies with agents targeting the DNA damage response (DDR) offer an opportunity to selectively enhance the therapeutic index of chemoradiation or eliminate chemotherapy altogether. The successful translation of DDR inhibitors to clinical use requires investigating both their direct actions as (chemo)radiosensitizers, and their potential to stimulate tumor immunogenicity. Beginning with high-throughput screening using both viability and DNA damage-reporter assays, followed by validation in ‘gold standard' radiation colony forming assays and in vitro assessment of mechanistic effects on the DDR we describe proven strategies and methods leading to the clinical development of DDR inhibitors both with radiation alone and in combination with chemoradiation. Beyond these in vitro studies, we discuss the impact of key features of human xenograft and syngeneic mouse models on the relevance of in vivo tumor efficacy studies, particularly with regard to the immunogenic effects of combined therapy with radiation and DDR inhibitors. Finally, we describe recent technological advances in radiation delivery (using the Small Animal Radiation Research Platform (SARRP)) that allow for conformal, clinically relevant radiation therapy in mouse models. Taken together, this overall approach is critical to the successful clinical development and ultimate FDA approval of DDR inhibitors as (chemo)radiation sensitizers.
Keywords: viability / DDR inhibitors / combined therapy / damage / conformal / efficacy / models / chemoradiation

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