mTOR inhibition amplifies the anti-lymphoma effect of PI3K beta/delta blockage in diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease that exhibits constitutive activation of phosphoinositide 3-kinase (PI3K) driven by chronic B-cell receptor signaling or PTEN deficiency. Since pan-PI3K inhibitors cause severe side effects, we investigated the anti-lymphoma efficacy of the specific PI3K beta/delta inhibitor AZD8186. We identified a subset of DLBCL models within activated B-cell-like (ABC) and germinal center B-cell-like (GCB) DLBCL that were sensitive to AZD8186 treatment. On the molecular level, PI3K beta/delta inhibition decreased the pro-survival NF-kappa B and AP-1 activity or led to downregulation of the oncogenic transcription factor MYC. In AZD8186-resistant models, we detected a feedback activation of the PI3K/AKT/mTOR pathway following PI3K beta/delta inhibition, which limited AZD8186 efficacy. The combined treatment with AZD8186 and the mTOR inhibitor AZD2014 overcame resistance to PI3K beta/delta inhibition and completely prevented outgrowth of lymphoma cells in vivo in cell line- and patient-derived xenograft mouse models. Collectively, our study reveals that subsets of DLBCLs are addicted to PI3K beta/delta signaling and thus identifies a previously unappreciated role of the PI3K beta isoform in DLBCL survival. Furthermore, our data demonstrate that combined targeting of PI3K beta/delta and mTOR is effective in all major DLBCL subtypes supporting the evaluation of this strategy in a clinical trial setting.