Synthetic lethality when combining phosphoinositide 3-kinase alpha and beta catalytic subunit-directed RNAi and estrogen deprivation for estrogen receptor positive breast cancer: implications for clinical trial design with pharmacological inhibitors.

Abstract Abstract #3063 Background: Endocrine therapy with estrogen deprivation (ED) induces cell cycle arrest in sensitive estrogen receptor positive (ER+) breast cancers, but typically not apoptosis, thus relapse is common despite ED due to residual surviving tumor cells. The phosphoinositide 3-kinase (PI3K) pathway, which promotes cell survival, is hyperactivated in ER+ breast cancer due to mutations of genes in the PI3K signaling cascade, most commonly PIK3CA. We therefore investigated the role of p110α and p110β, the gene products of PIK3CA and PIK3CB, in promoting cell survival in ER+ breast cancer. Materials and Methods: RNA interference (RNAi) was used to selectively inhibit p110α and p110β expression in the ER+, PIK3CA mutant MCF-7 and T47D cell lines; the ER+, PIK3CA wild-type but PIK3CB gene amplified HCC712 cell line; and the ER-, PIK3CA and PIK3CB wild-type MDA-MB-231 cell line. Western blotting was used to confirm p110α and p110β knockdown efficiencies and to determine the effects of specific knockdowns on PI3K pathway signaling. Cell line growth was measured using a resazurin reduction assay. Apoptosis was quantified using TUNEL/Hoechst staining. Gene copy number for PIK3CB was assessed by FISH in cell lines and tumor samples. Results: PIK3CA RNAi inhibited growth and activated apoptosis in all tested ER+ cell lines under ED, whereas the addition of estrogen reversed PIK3CA RNAi-induced apoptosis. PIK3CB RNAi inhibited proliferation and promoted apoptosis in the absence of estrogen only in the PIK3CB-gene amplified HCC712 cell line. In combination, PIK3CA and PIK3CB gene knockdowns produced a synergistic apoptotic effect on T47D and HCC712 cell lines, but not in MCF-7 cells which contain low levels of p110β protein. In contrast PIK3CA and PIK3CB RNAi did not promote apoptosis in the ER- MDA-MB-231 cell line. Finally, since PIK3CB gene amplification has not been described previously we conducted a screen by FISH and array CGH and detected low-level PIK3CB copy number gain or amplification in ∼5% of clinical samples from a series of breast cancer patients representing diverse clinical phenotypes (ER+, ER-, ERBB2+). Conclusions: Inhibition of the PI3K pathway through suppression of PI3K catalytic subunit expression produces a synthetic lethal effect in the absence of estrogen specifically in ER+ breast cancer cells. These data establish a preclinical rationale for combining endocrine therapy with PI3K pharmacological inhibitors in ER+ breast cancer, but suggest that both PIK3CA and PIK3CB are therapeutic targets and gene mutation or amplification in both catalytic subunits may have to be taken into account when identiying a sensitive population for PI3 kinase-directed therapy. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3063.

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