Abstract 4426: Targeting MCT1 and PFKFB3 provokes synthetic lethality in small cell lung cancer

Abstract Small cell lung cancer (SCLC) is the third most common lung cancer and is extremely aggressive and highly metastatic. SCLC responds to radiation and standard platinum-based chemotherapy, yet this is invariably followed by relapse and the rapid emergence of lethal chemoresistant disease. Hence, SCLC has been declared a recalcitrant malignancy by NCI, and there is an urgent need to identify new and actionable therapeutic vulnerabilities. Unbiased metabolomic and shotgun and activity-based proteomic analyses of NSCLC and SCLC patient derived tumor tissues, PDX and a panel of cell lines revealed marked upregulation of glycolytic and nucleotide metabolic pathways in SCLC. Further, unbiased screens with metabolic inhibitors revealed selective sensitivity of SCLC cells to the MCT1 lactate transporter inhibitor SR13800 and to the PFKFB3 inhibitor PFK15, and that combined treatment provokes rapid apoptosis. Metabolic, flux and molecular analyses revealed that MCT1 inhibition (MCT1i) or loss in SCLC cells impairs glycolysis and triggers rapid increases in intracellular lactate that then diminish, and this is driven by the induction of lactate dehydrogenase-B (LDH-B) that oxidizes lactate into pyruvate. This is accompanied by a marked shift in the NAD+ to NADH ratio towards NADH, and increased pyruvate dehydrogenase (PDH) activity and OXPHOS. Further, MCT1 inhibition provoked increases in the Aspartate-Malate and DHAP-SnG3P shuttles, which restored the NAD+/NADH balance in the cytosol. In contrast, treatment of SCLC cells with PFKFB3 inhibitors (PFKFB3i) leads to inhibition of PDH activity, a collapse in OXPHOS and increases in lactate efflux that are due to flux of glucose through pentose phosphate pathway and re-entry into glycolysis via 3-phosphoglygerate (3-PGA). Combined MCT1/PFKFB3 inhibition amplifies metabolic alterations provoked by both MCT1i and PFKFB3i, triggering a collapse in both glycolysis and OXPHOS. Similarly, inhibition or silencing of enzymes that drive the Aspartate-Malate and DHAP-SnG3P shuttles, or inhibition of the mitochondrial pyruvate transporter, provoked metabolic collapse and cell death following inhibition or loss of MCT1. Finally, SCLC xenografts and primary SCLC CDX treated with a combination of SR13800 and PFK15 showed improved survival compared to vehicle or monotherapy treatments. Thus, co-targeting adaptive metabolic circuits provoked by inhibition of MCT1 and PFKFB3 provokes synthetic lethality in SCLC, supporting the notion that inhibition of these metabolic chokepoints will be an effective strategy for treatment of this lethal malignancy. Citation Format: Antony Herold Prabhu, Kristen Scott, Paul Stewart, Daniel Grass, Mario Fernandez, Dalia Ercan, John Koomen, Thomas Bannister, Charles Rudin, Gina DeNicola, Eric Haura, John Cleveland. Targeting MCT1 and PFKFB3 provokes synthetic lethality in small cell lung cancer [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(6_Suppl):Abstract nr 4426.