Uveal melanoma (UM) is the most common intraocular tumor in adults. Nearly half of UM patients develop metastatic disease and survive one year or less. No effective therapy exists. Current interventions impair or destroy vision, yet do not improve morbidity or mortality caused by metastatic disease. Clinical trials of cytotoxic chemotherapeutics and immune checkpoint inhibitors have shown little efficacy. Mutant constitutively active forms of G?q/11 that drive oncogenesis in ~90% of UM patients thus far have been undruggable. Inhibitors of signaling molecules downstream of these oncoproteins have failed to demonstrate significant clinical benefit. Effective therapy may require breakthroughs that enable direct targeting of constitutively active G?q/11 or necessary but as yet unidentified downstream signaling cascades. This project fills these gaps by showing for the first time that constitutively active G?q/11 can be trapped pharmacologically in the inactive GDP-bound state, thereby attenuating downstream signaling. The inhibitor causes G?q/11-driven UM cells to arrest growth, die, or re-differentiate into melanocytic cells, whereas it has no effect on BRAF-driven UM cells. Inhibitor-treated UM cells has revealed a novel oncogenesis mechanism in which signaling by constitutively active G?q/11 antagonizes epigenetic silencing mediated by polycomb repressive complex 2 (PRC2) to drive de-differentiation. Based on these breakthroughs, the following Aims will be pursued: 1) Identify novel druggable targets that mediate signaling between constitutively active G?q/11 and PRC2 in UM cells; 2) Determine whether the G?q/11 inhibitor provides vision-sparing therapeutic benefit in mouse models of primary and metastatic UM; and 3) Set the stage for clinical trials by determining which clinical subclasses of human primary UM tumors respond ex vivo to the G?q/11 inhibitor. In summary, this project provides unprecedented opportunity to determine whether direct pharmacological inhibition of mutant constitutively active G?q/11 could provide the first effective and potentially vision-sparing therapeutic option for treating UM.
Uveal melanoma (UM) is a highly aggressive cancer that has no effective therapy. Current interventions impair or destroy vision, yet fail to improve morbidity or mortality caused by metastatic disease, which often is fatal within one year. The breakthrough driving this project is the identification of the first bioavailable inhibitor that directly targets the cancer driving protein in ~90% of UM patients; the proposed studies of this inhibitor in animal models of UM and patient-derived tumor samples could lead to the first rational, effective and potentially vision-sparing treatment option for UM patients.