Here, we use a large-scale cell line-based approach to identify cancer cell-specifi c mutations that are associated with DNA-dependent protein kinase catalytic subunit (DNA-PKcs) dependence. For this purpose, we profi led the mutational landscape across 1,319 cancerassociated genes of 67 distinct cell lines and identifi ed numerous genes involved in homologous recombination-mediated DNA repair, including BRCA1 , BRCA2 , ATM , PAXIP , and RAD50 , as being associated with non-oncogene addiction to DNA-PKcs. Mutations in the mismatch repair gene MSH3 , which have been reported to occur recurrently in numerous human cancer entities, emerged as the most signifi cant predictors of DNA-PKcs addiction. Concordantly, DNA-PKcs inhibition robustly induced apoptosis in MSH3 -mutant cell lines in vitro and displayed remarkable single-agent effi cacy against MSH3 -mutant tumors in vivo . Thus, we here identify a therapeutically actionable synthetic lethal interaction between MSH3 and the non-homologous end joining kinase DNA-PKcs. Our observations recommend DNA-PKcs inhibition as a therapeutic concept for the treatment of human cancers displaying homologous recombination defects.
SIGNIFICANCE:We associate mutations in the MSH3 gene, which are frequently detected in microsatellite-instable colon cancer (∼40%), with a therapeutic response to specifi c DNA-PKcs inhibitors. Because potent DNA-PKcs inhibitors are currently entering early clinical trials, we offer a novel opportunity to genetically stratify patients who may benefi t from a DNA-PKcs-inhibitory therapy. Cancer Discov; 4(5);[592][593][594][595][596][597][598][599][600][601][602][603][604][605]