G2/M Checkpoint Inhibition as a Novel Therapeutic Strategy for Esophageal Adenocarcinoma

Prevalence of esophageal adenocarcinoma (EAC) has increased six-fold in the United States over the past four decades due to increases in associated risk factors, namely obesity and gastroesophageal reflux disease. The most common genomic driver of EAC, tumor protein 53 (TP53) mutation, has previously been therapeutically intractable, affirming the unmet clinical need to deploy novel therapeutic strategies targeting this genomic driver in this tumor type. 72 percent of EAC patients have mutations in TP53, making tumors more reliant on the G2/M checkpoint to repair DNA damage, increasing likelihood of efficacious G2/M abrogation via targeting WEE1 G2 checkpoint kinase (WEE1), a modulator of this checkpoint. We hypothesize that the G2/M checkpoint represents a viable therapeutic avenue against the most common genomic driver of EAC. We investigated the efficacy of the WEE1 inhibitor AZD1775 on EAC cells. WEE1 mRNA expression levels in EAC are elevated compared to normal tissue controls. AZD1775 was shown to induce cyclin dependent kinase 1 (CDK1) mediated cell cycle progression and increased DNA damage markers as exposure increased via immunoblot analysis. SK-GT- 4 EAC cell line viability was significantly reduced by up to 30 percent when treated with AZD1775 and cisplatin when compared to cisplatin alone. AZD1775 monotherapy showed high efficacy in some EAC settings. Simultaneous dual therapy demonstrated the highest overall efficacy, and stepwise sequential treatments offered negligible benefit. Future research will explore the genomic contexts of the EAC celllines used in order to understand the different responses to AZD1775 monotherapy regimens. Ionizing radiotherapy will be employed in order to understand the DNA damage response timeline, providing more information on the mechanisms of G2/M checkpoint inhibitors in this disease setting. This research will provide insight into novel therapeutic targets for EAC leading to therapeutic testing and improved patient outcome.