LAUSR

Neuroblastoma is the most common extracranial solid tumor in children. Though it accounts for about 10% of pediatric cancers, it is disproportionately responsible for 15% of pediatric cancer deaths. MYCN is amplified in 20% of neuroblastomas and correlates with adverse outcome. MYCN is involved in the maintenance of cancer stem cells, as well as in driving tumor cell growth, proliferation and tumorigenesis. Attempts to inhibit MYCN directly have been largely unsuccessful. MYCN is known to drive tumor cell reliance on glutamine for cellular metabolism. 6-Diazo-5-oxo-L-norleucine (DON) is a well-characterized glutamine analogue that inhibits glutamine metabolism by irreversibly inactivating multiple glutamine-utilizing enzymes. DON was well tolerated in a previous phase I clinical trial in pediatric patients, but it has never been systematically tested in neuroblastoma patients. We show that MYCN-amplification confers sensitivity to DON therapy in in vitro models of neuroblastoma, and that DON administered by intraperitoneal injection twice weekly significantly reduces flank tumor volume in orthotopic mouse models of MYCN-amplified neuroblastoma (mean tumor volume 1715 mm3 vs. 207 mm3 in control animals, p-value = 0.00017 by t-test). We have also developed an orally bioavailable DON prodrug, JHU083, and we found that this drug administered orally three times weekly was similarly able to suppress neuroblastoma tumor growth in mice (mean tumor volume 1,115 mm3 vs. 217 mm3 in control animals, p-value = 0.0000088 by t-test). In metabolic flux experiments, tracing glutamine and glucose donation of 13C and 15N via liquid chromatography/mass spectrometry, DON prevents asparagine synthesis, depleting intracellular asparagine levels by 40% compared to control treated cells (p-value = 0.006). DON combined with L-asparaginase synergistically inhibits growth of MYCN-amplified neuroblastoma cell lines (CI = 0.25 by the Chou-Talalay method, indicating strong synergy; p-value = 0.00011). We conclude that DON depletes cellular pools of asparagine, and combination therapy with DON and L-asparaginase synergistically inhibits the growth of MYCN-amplified neuroblastoma. These studies provide the preclinical justification for potential clinical trials for the use of DON or DON prodrugs in combination with L-asparaginase as new therapeutic options for patients with MYCN-amplified neuroblastoma. Citation Format: Micah J. Maxwell, Brad Poore, Allison Hanaford, Jesse Alt, Rana Rais, Barbara S. Slusher, Charles G. Eberhart, Eric H. Raabe. Glutamine metabolic inhibition synergizes with L-asparaginase in MYCN-amplified neuroblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3521.