Patient-derived xenografts (PDXs) are resected human tumors engrafted into mice for preclinical studies and therapeutic testing. It has been proposed that the mouse host affects tumor evolution during PDX engraftment and propagation, affecting the accuracy of PDX modeling of human cancer. Here, we exhaustively analyze copy number alterations (CNAs) in 1,451 PDX and matched patient tumor (PT) samples from 509 PDX models. CNA inferences based on DNA sequencing and microarray data displayed substantially higher resolution and dynamic range than gene expression-based inferences, and they also showed strong CNA conservation from PTs through late-passage PDXs. CNA recurrence analysis of 130 colorectal and breast PT/PDX-early/PDX-late trios confirmed high-resolution CNA retention. We observed no significant enrichment of cancer-related genes in PDX-specific CNAs across models. Moreover, CNA differences between patient and PDX tumors were comparable to variations in multiregion samples within patients. Our study demonstrates the lack of systematic copy number evolution driven by the PDX mouse host.

41 a PDXNET consortium 42 b EurOPDX consortium 43 # These authors contributed equally to this work.44 § These authors jointly supervised this work. ABSTRACT 107Patient-derived xenografts (PDXs) are resected human tumors engrafted into mice for preclinical 108 studies and therapeutic testing. It has been proposed that the mouse host affects tumor evolution 109 during PDX engraftment and propagation, impacting the accuracy of PDX modeling of human 110 cancer. Here we exhaustively analyze copy number alterations (CNAs) in 1451 PDX and matched 111 patient tumor (PT) samples from 509 PDX models. CNA inferences based on DNA sequencing 112 and microarray data displayed substantially higher resolution and dynamic range than gene 113 expression-based inferences, and they also showed strong CNA conservation from PTs through 114 late-passage PDXs. CNA recurrence analysis of 130 colorectal and breast PT/PDX-early/PDX-115 late trios confirmed high-resolution CNA retention. We observed no significant enrichment of 116 cancer-related genes in PDX-specific CNAs across models. Moreover, CNA differences between 117 patient and PDX tumors were comparable to variations in multi-region samples within patients. 118Our study demonstrates the lack of systematic copy number evolution driven by the PDX mouse 119 host. 121 MAIN 122A variety of models of human cancer have been used to study basic biological processes and 123 predict responses to treatment. For example, mouse models with genetically engineered 124 mutations in oncogenes and tumor suppressor genes have clarified the genetic and molecular 125 basis of tumor initiation and progression 1,2 , though responses sometimes differ between human 126 and mouse 3 . Cell lines have also been widely used to study cancer cells, but they lack the 127 heterogeneity and microenvironment of in vivo tumors and have shown limitations for predicting 128 clinical response 4 . Human tumors engrafted into transplant-compliant recipient mice (patient-129 derived xenografts, PDX) have advantages over prior systems for preclinical drug efficacy studies 130 because they allow researchers to directly study human cells and tissues in vivo 5-8 . Comparisons131 of genome characteristics and histopathology of primary tumors and xenografts of human breast 132 cancer 9-13 , ovarian cancer 14 , colorectal cancer 15 and lung cancer 16-18 , have demonstrated that the 133 biological properties of patient-derived tumors are largely preserved in xenografts. A growing body 134 of literature supports their use in cancer drug discovery and development 19-21 . 135A caveat to PDX models is that intratumoral evolution can occur during engraftment and 136 passaging 11,22-25 . Such evolution could potentially modify treatment response of PDXs with 137 respect to the patient tumors 23,26,27 , particularly if the evolution were to systematically alter cancer-138 related genes. This issue is related to multi-region comparisons of patient tumors 28-31 , for which 139 local mutational and immune infiltration variations have sugg...

Resistance to chemotherapy often results from dysfunctional apoptosis, however multiple proteins with overlapping functions regulate this pathway. We sought to determine whether an extensively validated, deterministic apoptosis systems model, ‘DR_MOMP’, could be used as a stratification tool for the apoptosis sensitiser and BCL-2 antagonist, ABT-199 in patient-derived xenograft (PDX) models of colorectal cancer (CRC). Through quantitative profiling of BCL-2 family proteins, we identified two PDX models which were predicted by DR_MOMP to be sufficiently sensitive to 5-fluorouracil (5-FU)-based chemotherapy (CRC0344), or less responsive to chemotherapy but sensitised by ABT-199 (CRC0076). Treatment with ABT-199 significantly improved responses of CRC0076 PDXs to 5-FU-based chemotherapy, but showed no sensitisation in CRC0344 PDXs, as predicted from systems modelling. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scans were performed to investigate possible early biomarkers of response. In CRC0076, a significant post-treatment decrease in mean standard uptake value was indeed evident only in the combination treatment group. Radiomic CT feature analysis of pre-treatment images in CRC0076 and CRC0344 PDXs identified features which could phenotypically discriminate between models, but were not predictive of treatment responses. Collectively our data indicate that systems modelling may identify metastatic (m)CRC patients benefitting from ABT-199, and that 18F-FDG-PET could independently support such predictions.

Purpose: Regorafenib (REG) is approved for the treatment of metastatic colorectal cancer, but has modest survival benefit and associated toxicities. Robust predictive/early response biomarkers to aid patient stratification are outstanding. We have exploited biological pathway analyses in a patient-derived xenograft (PDX) trial to study REG response mechanisms and elucidate putative biomarkers. Experimental Design: Molecularly subtyped PDXs were annotated for REG response. Subtyping was based on gene expression (CMS, consensus molecular subtype) and copy-number alteration (CNA). Baseline tumor vascularization, apoptosis, and proliferation signatures were studied to identify predictive biomarkers within subtypes. Phospho-proteomic analysis was used to identify novel classifiers. Supervised RNA sequencing analysis was performed on PDXs that progressed, or did not progress, following REG treatment. Results: Improved REG response was observed in CMS4, although intra-subtype response was variable. Tumor vascularity did not correlate with outcome. In CMS4 tumors, reduced proliferation and higher sensitivity to apoptosis at baseline correlated with response. Reverse phase protein array (RPPA) analysis revealed 4 phospho-proteomic clusters, one of which was enriched with non-progressor models. A classification decision tree trained on RPPA- and CMS-based assignments discriminated non-progressors from progressors with 92% overall accuracy (97% sensitivity, 67% specificity). Supervised RNA sequencing revealed that higher basal EPHA2 expression is associated with REG resistance. Conclusions: Subtype classification systems represent canonical “termini a quo” (starting points) to support REG biomarker identification, and provide a platform to identify resistance mechanisms and novel contexts of vulnerability. Incorporating functional characterization of biological systems may optimize the biomarker identification process for multitargeted kinase inhibitors.

A Correction to this paper has been published: https://doi.org/10.1038/s41588-021-00811-4.