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Abstract Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with a dismal prognosis. The availability of new therapies and biomarkers for patients’ selection is still an urgent need. Altered lipid metabolism, which has been reported in several tumors, has not yet been studied in DMPM. By comparatively analyzing gene expression profiles of tumors form relapsed (n=18) and non-relapsed (n=18) DMPM patients, we initially found that fatty acid synthase (FASN) was up-modulated in relapsed tumors, with a significant linear correlation between FASN expression and shorter patient relapse-free survival (RFS), suggesting a potential role of FASN in DMPM progression. The prognostic significance of FASN was further assessed in a cohort of 80 DMPM patients who underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. Our results indicated that high FASN staining was significantly associated with reduced RFS (hazard ration (HR): 1. 930; p=0. 014) and Overall Survival (OS) (HR: 1. 854; p=0. 032) as assessed by immunohistochemistry in tissues microarray samples. The prognostic value of FASN, along with Ki67 staining and patient age, was also maintained in multivariate analysis in terms of both RFS (HR: 2. 240; p=0. 007) and OS (HR: 2. 246; p=0. 014). To validate FASN as a therapeutic target, we investigated the cytotoxic effects of non-selective (orlistat) and selective (cerulenin and C75) FASN inhibitors on patient-derived DMPM cell lines, both as single agents and in combination with selinexor -a selective inhibitor of the exportin chromosome maintenance protein. FASN pharmacological inhibition in DMPM cells resulted in a significant reduction of cell proliferation, especially upon C75 exposure. In combination experiments, we observed a synergistic activity of FASN inhibitors and selinexor, as determined by Chou and Talalay method. Through western blotting and flow cytometry analysis, we gained further insight into the mechanisms by which FASN inhibitors and selinexor synergize to reduce DMPM cell proliferation. Compared to single agents, the combined treatments resulted in increased apoptosis response and cell cycle impairment, as indicated by caspase-dependent apoptosis activation and cell accumulation in the G2-phase. Overall, our results support the relevance of FASN as a prognostic biomarker for DMPM patients and underscore its potential as a novel therapeutic target. Citation Format: Valentina Doldi, Silvia Martini, Chiara Maura Ciniselli, Alessia Beretta, Marcello Deraco, Shigeki Kusamura, Dario Baratti, Paolo Gandellini, Paolo Verderio, Nadia Zaffaroni. Fatty acid synthase as a novel prognostic biomarker and a potential therapeutic target in diffuse malignant peritoneal mesothelioma 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 4642.
Doldi et al. (Fri,) studied this question.