Background: Sub-groups of breast, lung, and colon cancer patients with genetic variants associated with dysregulated ErbB signaling benefit from treatment with ErbB targeted therapies. No sub-groups of ovarian cancer patients with actionable ErbB genetic variants have yet been found. Measurement of biological factors other than genetic variants, such as ErbB signaling activity, may identify ovarian cancer patients likely to benefit from ErbB targeted therapies. We have previously reported studies detecting dysregulated ErbB and c-Met signaling activity in 20%-25% of HER2-negative breast cancer patient tumors using the CELx Multi-Pathway (MP) Signaling Function Test. To determine whether ErbB or c-Met signaling dysregulation is involved in ovarian cancer, the CELx MP test was adapted to analyze ovarian tumor cells. The current study set out to: 1) characterize c-Met and ErbB family signaling activity in ovarian patient tumor cells and ovarian tumor cell lines; 2) evaluate in vivo response to pan-HER and c-Met inhibitors in an ovarian tumor xenograft model.

Methods: For the ex vivo studies, a set of fresh tumor specimens from 15 ovarian cancer patients (90% high-grade serous, 10% endometrioid) and a set of 12 ovarian cancer cell lines was obtained. Cell samples were cultured from each patient specimen. Real-time live cell response to specific ErbB and c-Met agonists (NRG1b, EGF, or HGF) with or without an antagonist (2C4, a HER2 dimerization inhibitor or tepotinib, a c-Met kinase inhibitor) was measured and quantified using an xCELLigence impedance biosensor (Agilent Technologies). Signaling activity above a previously established cut-off value was used to identify abnormal levels of EGFR, HER2 and c-Met signaling activity. For the xenograft study, OVCAR-4, an ovarian cancer cell line, determined to have abnormal HER2, EGFR, and c-Met signaling with the CELx MP Test, was studied. 40 female NSG mice were injected with two million OVCAR-4 cells. Mice were randomly assigned to either a control group that received Captisol excipient or a treatment group that received neratinib, tepotinib, or neratinib and tepotinib for 16 days.

Results: Of the patient cell and cell lines samples tested ex vivo with the CELx MP test, 4 of 27 (15%; 95% CI=6%-32%) had hyperactive HER2 and c-Met signaling pathways. In the xenograft study, there was no significant difference in tumor volume between the control and tepotinib-treated or neratinib groups after 16 days of treatment. Tumor volumes relative to tumor size before treatment were reduced by 40% in the tepotinib + neratinib treated group.

Conclusions: These findings suggest that a significant sub-group of ovarian cancer patients have abnormal ErbB and c-Met signaling activity that may respond to treatment with a combination of ErbB and c-Met inhibitors. A clinical trial to evaluate treatment response of this patient sub-set to combined c-Met and pan-HER inhibitors is warranted.