Stem-23. GBM Neurodevelopmental Lineage Plasticity Drives Rapid Adaptation to Oncogene Targeted Therapy

Phenotypic plasticity plays a pivotal role in cancer, enabling tumor cells to adapt to environmental pressures and evade therapeutic interventions by transitioning between distinct cellular states. However, the contribution of phenotypic plasticity to adaptive drug resistance in glioblastoma (GBM), one of the most lethal of all cancers, remains poorly understood. In this study, we identify that GBM tumor-initiating cells resembling normal radial glia (RG), which occupy the apex of normal neurodevelopment, are driven by aberrant epidermal growth factor receptor (EGFR) signaling. Using a suite of patient-derived GBM models, we demonstrate through global proteomics and single-cell RNA sequencing that pharmacological inhibition of EGFR triggers a lineage transition toward neuronal and oligodendrocyte progenitor (OPC)-like states. This shift is accompanied by activation of oncogenic RAS-MAPK signaling – despite robust and durable inhibition of EGFR activation – and is further modulated by brain microenvironmental cues, including synaptic and calcium-mediated signaling programs. Dual inhibition of EGFR and RAS-MAPK with novel, tumor-selective small molecules blocks these phenotypic transitions and enhances GBM cell death in EGFR-mutated GBM models. To determine the subpopulation dynamics of RAS-MAPK signaling within GBM neurodevelopmental lineages, we develop DENALI (Dual-Expression Nuclear reporter of ERK Activity and Lineage Identity) – a novel, high-complexity barcoded lentiviral vector and integrative fluorescence reporter system. Using DENALI, we investigate the clonal mechanisms driving lineage plasticity in GBM following oncogenic EGFR inhibition and couple adaptive RAS signaling programs to the emergence of neuronal and OPC-like states under EGFRi therapy. Together, our findings establish neurodevelopmental lineage plasticity as a key driver of adaptive resistance in GBM and support dual-inhibition strategies to improve therapeutic outcomes in patients with GBM tumors.