Abstract 2126: Efficacy and underlying mechanisms of surufatinib in non-small cell lung cancer treatment

Abstract Background: The prevalence and fatality of lung cancer, especially non-small cell lung cancer (NSCLC), highlight the urgency for efficacious therapies. Surufatinib, an inhibitor of tyrosine kinases like VEGF receptors (VEGFR) 1, 2, and 3, Fibroblast growth factor receptor 1 (FGFR1), and CSF-1R, shows potential in augmenting chemotherapy efficacy and reducing adverse effects. Preliminary clinical studies (NCT04922658) have indicated survival benefits for NSCLC patients treated with surufatinib. This investigation seeks to delineate the therapeutic efficacy of surufatinib, correlating clinical benefits with mechanistic insights. Methods: To elucidate mechanisms, proliferation assays (CCK8), migration (scratch assay), and apoptosis (flow cytometry) were conducted in A549 and H1299 cell lines. Angiogenesis and macrophage polarization were examined via vascular junction points and mRNA expression profiling. In nude mice, subcutaneous tumors were induced and treated with the study drugs, with tumor growth and angiogenic markers assessed. Results: In vitro, surufatinib potently inhibited angiogenesis and exerted a dose-dependent suppression of proliferation and colony formation in lung cancer A549 and PC9 cell lines. It also enhanced apoptosis and cell migration. Additionally, surufatinib shifted macrophage polarization towards an M1 phenotype while diminishing M2 macrophages, thereby, contributing to a more robust anti-tumor immune milieu. In vivo studies corroborated these findings, with surufatinib and vinorelbine combination therapy significantly curtailing tumor growth and reducing CD31 expression in tumor tissues, highlighting its potential for substantial therapeutic gains in NSCLC management. Conclusion: Surufatinib achieved notable antitumor effect consistent with clinical findings in NSCLC, effectively inhibiting cellular proliferation and migration, attenuating angiogenesis, and enhancing apoptosis. Significantly, it also modulated macrophage polarization to favor an M1/M2 balance, thus activating the immune response. Therapeutic strategies with surufatinib have underscored augmented antineoplastic efficacy, meriting additional clinical investigations. Citation Format: Yanfang Zheng, Binjie Shan, Meng Wang, Xiaoran Wu, Rui Cai, Feiyu Niu, Yan Yuan, Lu Liu, Xiongjie Zhu. Efficacy and underlying mechanisms of surufatinib in non-small cell lung cancer treatment 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 2126.