Abstract 5618: Evaluating the combination of datopotamab deruxtecan (Dato-DXd) with AZD5305, a highly potent, PARP1-selective inhibitor, -in preclinical models

Abstract Background: Dato-DXd is a TROP2-directed antibody drug conjugate comprised of a topoisomerase I inhibitor (an exatecan derivative, DXd) conjugated to datopotamab, a humanized anti-TROP2 IgG1 antibody, via a cleavable plasma-stable tetrapeptide-based linker. Topoisomerase I inhibitors stabilize DNA-topoisomerase cleavage complexes (Topo1cc) that lead to double-strand breaks and activation of DNA damage response (DDR). Poly (ADP-ribose) polymerase 1 (PARP1) mediates signal transduction in the DDR as an important regulator. AZD5305 is a highly potent and selective inhibitor of PARP1. Since PARP1 is a key component driving the repair of trapped Topo1cc, we aimed to investigate if combinations of Dato-DXd with AZ5305 lead to synergistic anti-tumor effects in preclinical models. Methods: We evaluated the cytotoxic effect of the combination of Dato-DXd with AZD5305 in a panel of six non-small cell lung cancer (NSCLC) and five triple negative breast cancer (TNBC) cell lines in a 7-day viability assay. We evaluated PARylation inhibition and gH2AX response by Western blotting. Topo1cc accumulation in response to combination treatment was evaluated by immunofluorescence. This combination was evaluated in vivo in TROP2+, HRD-negative gastric cancer (GC) N87 cell line xenograft at varying concentrations of AZD5305 and in a TROP2+, PARPi-resistant Ovarian cancer patient derived xenograft (PDX) model (CTG-3718). Results: The in vitro combination screen demonstrated enhanced cell killing by the Dato-DXd and AZD5305 combination over either single agent in both NSCLC and TNBC cell lines. Combination benefit was observed at all doses regardless of homologous recombination deficiency (HRD) status. We observed dose-dependent increase in PARylation inhibition and enhanced induction of gH2AX in the combination treatment. In a N87 tumor model, while Dato-DXd and AZD5305 provided 84% and 31% tumor growth inhibition (TGI) as monotherapies respectively, the addition of AZD5305 to Dato-DXd resulted in 95% TGI. This effect was observed with multiple dose levels of AZD5305. In a TROP2+, ovarian cancer PDX model, AZD5305 demonstrated limited monotherapy activity (10% TGI) and Dato-DXd demonstrated robust monotherapy activity with 72% TGI. Additional anti-tumor activity was observed for the combination treatment compared to either monotherapy with 88% TGI. All treatment groups were well tolerated in vivo. Conclusion: Dato-DXd combination with AZD5305 increased cytotoxic activity and pharmacodynamic response in vitro. This combination led to superior tumor growth inhibition in a GC xenograft model and a PARP1i-resistant Ovarian PDX model in vivo. These pre-clinical findings support the ongoing clinical evaluation of Dato-DXd as a monotherapy and in combination with AZD5305 in patients with various advanced solid tumor types (NCT05489211, NCT04644068). Citation Format: Gopi Patel, Joe’l Owusu, Chetan Rane, Alan Rosen, Matthew Griffin, Matthew Sung. Evaluating the combination of datopotamab deruxtecan (Dato-DXd) with AZD5305, a highly potent, PARP1-selective inhibitor, -in preclinical models 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 5618.