ATR addiction in multiple myeloma: synthetic lethal approaches exploiting established therapies

A Botrugno Oronza A Botrugno, Bianchessi Silvia Bianchessi, Zambroni Desirée Zambroni, Frenquelli Michela Frenquelli, Belloni Daniela Belloni, Bongiovanni Lucia Bongiovanni, Girlanda Stefania Girlanda, Di Terlizzi Simona Di Terlizzi, Ferrarini Marina Ferrarini, Ferrero Elisabetta Ferrero, Ponzoni Maurilio Ponzoni, Marcatti Magda Marcatti, Tonon Giovanni Tonon

Research output: Contribution to journalArticlepeer-review


Therapeutic strategies designed to tinker with cancer cell DNA damage response have led to the widespread use of PARP inhibitors for BRCA1/2-mutated cancers. In the haematological cancer multiple myeloma, we sought to identify analogous synthetic lethality mechanisms that could be leveraged upon established cancer treatments. The combination of ATR inhibition using the compound VX-970 with a drug eliciting interstrand cross-links, melphalan, was tested in in vitro, ex vivo, and most notably in vivo models. Cell proliferation, induction of apoptosis, tumor growth and animal survival were assessed. The combination of ATM inhibition with a drug triggering double strand breaks, doxorucibin, was also probed. We found that ATR inhibition is strongly synergistic with melphalan, even in resistant cells. The combination was dramatically effective in targeting myeloma primary patient cells and cell lines reducing cell proliferation and inducing apoptosis. The combination therapy significantly reduced tumor burden and prolonged survival in animal models. Conversely, ATM inhibition only marginally impacted on myeloma cell survival, even in combination with doxorucibin at high doses. These results indicate that myeloma cells extensively rely on ATR, but not on ATM, for DNA repair. Our findings posit that adding an ATR inhibitor such as VX-970 to established therapeutic regimens may provide a remarkably broad benefit to myeloma patients.

Original languageEnglish
Pages (from-to)2440-2447
Number of pages8
Issue number10
Publication statusPublished - Nov 14 2019
Externally publishedYes

ASJC Scopus subject areas

  • Hematology

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