Reversal of lineage plasticity in RB1/TP53-deleted prostate cancer through FGFR and Janus kinase inhibition

The inherent plasticity of tumor cells provides a mechanism of resistance to many molecularly targeted therapies, exemplified by adeno-to-neuroendocrine lineage transitions seen in prostate and lung cancer. Here we investigate the root cause of this lineage plasticity in a primary murine prostate organoid model that mirrors the lineage transition seen in patients. These cells lose luminal identity within weeks following deletion of Trp53 and Rb1, ultimately acquiring an Ar-negative, Syp+ phenotype after orthotopic in vivo transplantation. Single-cell transcriptomic analysis revealed progressive mixing of luminal-basal lineage features after tumor suppressor gene deletion, accompanied by activation of Jak/Stat and Fgfr pathway signaling and interferon-a and -g gene expression programs prior to any morphologic changes. Genetic or pharmacologic inhibition of Jak1/2 in combination with FGFR blockade restored luminal differentiation and sensitivity to antiandrogen therapy in models with residual AR expression. Collectively, we show lineage plasticity initiates quickly as a largely cell-autonomous process and, through newly developed computational approaches, identify a pharmacological strategy that restores lineage identity using clinical grade inhibitors. Six prostate organoid samples: Wild-type prostate organoid isolated from TP53 loxP/loxP and RB1 loxP/loxP mice and cultured under standard organoid conditions with dihydrotestosterone (DHT) exposure Prostate organoid at 2 weeks following cre mediated RB1 and TP53 deletion and cultured under standard organoid conditions with dihydrotestosterone (DHT) exposure Prostate organoid at 4 weeks following cre mediated RB1 and TP53 deletion and cultured under standard organoid conditions with dihydrotestosterone (DHT) exposure Prostate organoid at 8 weeks following cre mediated RB1 and TP53 deletion and cultured under standard organoid conditions with dihydrotestosterone (DHT) exposure Prostate organoid at 4 weeks following cre mediated RB1 and TP53 deletion and cultured under standard organoid conditions withre enzalutamide (ENZ) exposure Prostate organoid at 8 weeks following cre mediated RB1 and TP53 deletion and cultured under standard organoid conditions withre enzalutamide (ENZ) exposure