You are here

Cancer Discov DOI:10.1158/2159-8290.CD-21-0702

Parallel Genomic Alterations of Antigen and Payload Targets Mediate Polyclonal Acquired Clinical Resistance to Sacituzumab Govitecan in Triple-Negative Breast Cancer.

Publication TypeJournal Article
Year of Publication2021
AuthorsCoates, JT, Sun, S, Leshchiner, I, Thimmiah, N, Martin, EE, McLoughlin, D, Danysh, BP, Slowik, K, Jacobs, RA, Rhrissorrakrai, K, Utro, F, Levovitz, C, Denault, E, Walmsley, CS, Kambadakone, A, Stone, JR, Isakoff, SJ, Parida, L, Juric, D, Getz, G, Bardia, A, Ellisen, LW
JournalCancer Discov
Date Published2021 Oct

Sacituzumab govitecan (SG), the first antibody-drug conjugate (ADC) approved for triple-negative breast cancer, incorporates the anti-TROP2 antibody hRS7 conjugated to a topoisomerase-1 (TOP1) inhibitor payload. We sought to identify mechanisms of SG resistance through RNA and whole-exome sequencing of pretreatment and postprogression specimens. One patient exhibiting progression lacked TROP2 expression, in contrast to robust TROP2 expression and focal genomic amplification of observed in a patient with a deep, prolonged response to SG. Analysis of acquired genomic resistance in this case revealed one phylogenetic branch harboring a canonical resistance mutation and subsequent frameshift mutation, whereas a distinct branch exhibited a novel / missense mutation. Reconstitution experiments demonstrated that TROP2 confers SG resistance via defective plasma membrane localization and reduced cell-surface binding by hRS7. These findings highlight parallel genomic alterations in both antibody and payload targets associated with resistance to SG. SIGNIFICANCE: These findings underscore TROP2 as a response determinant and reveal acquired SG resistance mechanisms involving the direct antibody and drug payload targets in distinct metastatic subclones of an individual patient. This study highlights the specificity of SG and illustrates how such mechanisms will inform therapeutic strategies to overcome ADC resistance..


Alternate JournalCancer Discov
PubMed ID34404686
PubMed Central IDPMC8495771
Grant ListK99 CA259447 / CA / NCI NIH HHS / United States
S10 RR031563 / RR / NCRR NIH HHS / United States