Compositions and methods for sensitizing a neoplastic cell to radiation
The invention provides for the use of radiation sensitizing agents in combination with radiation for the treatment of neoplasia, methods for the identification of genotype-specific radiation sensitizing agents, and methods of identifying patients who could benefit from therapy with a genotype-specific radiation sensitizing agent.
1. A method of sensitizing a neoplastic cell to radiation, the method comprising: contacting the cell with a radiation sensitizing small molecule PI3 kinase alpha selective inhibitor which reduces or inhibits NRF2 expression or activity in the cell, and exposing the cell to radiation, thereby sensitizing the cell to radiation, wherein the cell comprises a radiation susceptible TP53 mutation selected from the group consisting of W146*, E171*, Q167*, E298*, V143A, D259V, R249S, M2371, V272M, V143M, R248W, R158G Intron (ins) and a combination thereof in the TP53 DNA binding domain.
2. The method of claim 1 , wherein the cell is characterized by NRF2 activation.
3. The method of claim 1 , wherein the neoplastic cell is a lung cancer cell.
4. The method of claim 3 , wherein the lung cancer cell is a non-small cell lung cancer cell.
5. The method of claim 4 , wherein the cell is characterized by NRF2 activation.
6. The method of claim 1 , wherein the PI3 kinase alpha selective inhibitor is LY 294002 or NVP-BKM120.
7. The method of claim 1 , wherein the PI3 kinase alpha selective inhibitor is genistein or wortmannin.
8. The method of claim 1 , wherein the cell further comprises an NFE2L2 mutation.
9. The method of claim 8 , wherein the NFE2L2 mutation is D77V, P128L, or E79K.
10. A method of enhancing cell death or reducing proliferation in a neoplastic cell, the method comprising contacting the cell with a radiation sensitizing small molecule PI3 kinase alpha selective inhibitor which inhibits NRF2 expression or translocation and exposing the cell to radiation, thereby enhancing cell death or reducing proliferation in said neoplastic cell, wherein the cell comprises a radiation susceptible TP53; wherein the TP53 mutation is selected from the group consisting of W146*, E171*, Q167*, E298*, V143A, D259V, R249S, M2371, V272M, V143M, R248W, R158G Intron (ins) and a combination thereof in the TP53 DNA binding domain.
11. The method of claim 10 , wherein the neoplastic cell is a lung cancer cell.
12. The method of claim 11 , wherein the lung cancer cell is a non-small cell lung cancer cell.
13. The method of claim 10 , wherein the PI3 kinase alpha selective inhibitor is LY 294002 or NVP-BKM120.
14. The method of claim 10 , wherein the PI3 kinase alpha selective inhibitor is genistein or wortmannin.
15. The method of claim 10 , wherein the cell further comprises an NFE2L2 mutation.
16. The method of claim 15 , wherein the NFE2L2 mutation is D77V, P128L, or E79K.
17. A method of enhancing radiation sensitivity in a subject having a radiation-resistant neoplasia, the method comprising administering to the subject radiation and a radiation sensitizing small molecule PI3 kinase alpha selective inhibitor which inhibits NRF2 expression or activity, wherein radiation resistance is characterized by detecting a TP53 mutation associated with radiation resistance in a cell of the neoplasia; wherein the TP53 mutation is selected from the group consisting of W146*, E171*, Q167*, E298*, V143A, D259V, R249S, M2371, V272M, V143M, R248W, R158G Intron (ins) and a combination thereof in the TP53 DNA binding domain.
18. The method of claim 17 , wherein the radiation-susceptibility of the neoplasia is characterized prior to, during, or following administration of radiation.
19. The method of claim 17 , wherein a TP53 missense mutation identifies the neoplasia as radiation resistant and a TP53 disruptive mutation identifies the neoplasia as radiation sensitive.
20. The method of claim 17 , wherein the PI3 kinase inhibitor is LY 294002 or NVP-BKM120.
21. The method of claim 17 , wherein the neoplastic cell is a lung cancer cell.
22. The method of claim 21 , wherein the lung cancer cell is a non-small cell lung cancer cell.
23. The method of claim 17 , wherein the PI3 kinase alpha selective inhibitor is administered to the subject prior to, concurrently with, or subsequent to the administration of radiation.
24. The method of claim 17 , wherein the PI3 kinase alpha selective inhibitor is genistein or wortmannin.
25. The method of claim 17 , wherein the cell of the neoplasia further comprises an NFE2L2 mutation.
26. The method of claim 25 , wherein the NFE2L2 mutation is D77V, P128L, or E79K.