Targeting FGFRs Using PD173074 as a Novel Therapeutic Strategy in Cholangiocarcinoma

Cholangiocarcinoma (CCA) is an architecturally complex and highly heterogeneous tumour and is difficult to diagnose at early stages due to its late onset and asymptomatic nature. Recent studies have focused on the Fibroblast Growth Factor Receptors (FGFRs), a sub-family of Tyrosine Kinase Receptors (RTKs), as promising targets for therapy. Pemigatinib, a small-molecule inhibitor of FGFR, was the first FDA-approved targeted therapy drug for CCA patients with FGFR2 fusions who had failed first-line chemotherapy. However, only a limited cohort of patients benefit from this therapeutic strategy as the mutation does not necessarily correlate to the response. In this study, aberrant FGFR expression in CCA samples was found using a bioinformatics approach and further confirmed by immunohistochemistry. PD173074, a selective pan-FGFR inhibitor, was found to be sensitive to CCA cell lines with FGFR expression, suggesting that it can be used to suppress CCA cells even without the FGFR2 fusions. Moreover, correlation analysis of publicly available cohorts suggested the possibility of crosstalk amongst the FGFR and EGFR family of receptors and dual inhibition of PD173074 and erlotinib was found to be synergistic in CCA using cell lines and patient-derived complex models. Thus, this study suggests further clinical investigation of PD173074, as well as other FGFR inhibitors, to benefit a larger cohort of CCA patients and novel therapeutic strategies involving dual inhibition of FGFRs and EGFR. Cholangiocarcinoma (CCA) is an architecturally complex tumour with high heterogeneity. Discovery at later stages makes treatment challenging. However, the lack of early detection methodologies and the asymptomatic nature of CCA make early diagnosis more difficult. Recent studies revealed the fusions in Fibroblast Growth Factor Receptors (FGFRs), a sub-family of RTKs, as promising targets for targeted therapy for CCA. Particularly, FGFR2 fusions have been of particular interest, as translocations have been found in approximately 13% of CCA patients. Pursuing this, Pemigatinib, a small-molecule inhibitor of FGFR, became the first targeted therapy drug to be granted accelerated approval by the FDA for treating CCA patients harbouring FGFR2 fusions who have failed first-line chemotherapy. However, despite the availability of Pemigatinib, a very limited group of patients benefit from this treatment. Moreover, as the underlying mechanism of FGFR signalling is poorly elucidated in CCA, therapeutic inhibitors designed to inhibit this pathway are prone to primary and acquired resistance, as witnessed amongst other Tyrosine Kinase Inhibitors (TKIs). While acknowledging the limited cohort that benefits from FGFR inhibitors, and the poorly elucidated mechanism of the FGFR pathway, we sought to characterise the potential of FGFR inhibitors in CCA patients without FGFR2 fusions. Here we demonstrate aberrant FGFR expression in CCA samples using bioinformatics and further confirm phosphorylated-FGFR expression in paraffinised CCA tissues using immunohistochemistry. Our results highlight p-FGFR as a biomarker to guide FGFR-targeted therapies. Furthermore, CCA cell lines with FGFR expression were sensitive to a selective pan-FGFR inhibitor, PD173074, suggesting that this drug can be used to suppress CCA cells irrespective of the FGFR2 fusions. Finally, the correlation analysis utilising publicly available cohorts suggested the possibility of crosstalk amongst the FGFR and EGFR family of receptors as they are significantly co-expressed. Accordingly, dual inhibition of FGFRs and EGFR by PD173074 and EGFR inhibitor erlotinib was synergistic in CCA. Hence, the findings from this study provide support for further clinical investigation of PD173074, as well as other FGFR inhibitors, to benefit a larger cohort of patients. Altogether, this study shows for the first time the potential of FGFRs and the importance of dual inhibition as a novel therapeutic strategy in CCA.

Automated summary

Cholangiocarcinoma (CCA) is a complex and heterogeneous tumor that is difficult to diagnose at early stages due to its asymptomatic nature. Recent studies have focused on using Fibroblast Growth Factor Receptors (FGFRs) as targets for therapy. This study found aberrant FGFR expression in CCA samples using a bioinformatics approach and confirmed it with immunohistochemistry. The selective pan-FGFR inhibitor PD173074 was effective in suppressing CCA cells with FGFR expression, and dual inhibition of FGFRs and EGFR showed synergistic effects in CCA.