EXTH-32 - Synergistic efficacy of Y box binding protein 1 (YBX1) inhibition combined with chemotherapy for the treatment of MYC-amplified medulloblastoma

Medulloblastoma is the most common pediatric brain tumor in children. Patients diagnosed with MYC-amplified group 3 (G3) have a dismal prognosis with a 5 year survival rate of < 50%. Standard of care consists of maximal resection surgery followed by craniospinal irradiation and chemotherapy, but patients experience diminished quality of life from these extensive treatment regimens. Recent observations have shown that Y-box binding protein 1 (YBX1) is upregulated across human medulloblastoma subgroups compared to normal cerebellum. G3 patient tumors have the highest expression of YBX1, possibly due to an oncogenic feedback loop. We utilized an orthogonal pharmacogenetic approach to target YBX1. Knockdown/out of YBX1 significantly inhibits proliferation of G3 MB cells in vitro and in vivo. We next investigated the therapeutic potential of a novel YBX1 inhibitor, which displays single agent efficacy at decreasing the proliferation of medulloblastoma cell line derived xenografts (CDX). Since YBX1 targeting downregulated ABC transporter expression, we hypothesize that inhibition of YBX1 may sensitize medulloblastoma cells to chemotherapeutic agents. We performed drug synergy experiments combining YBX1 inhibition and commonly used standard of care chemotherapy. We identify that combining YBX1 inhibition sensitizes to both gemcitabine and vincristine in vitro and in vivo. We are currently evaluating this YBX1 inhibitor in an “anchor-probe” screen combining with all currently FDA approved drugs. Our findings impart an alluring prospect of targeting YBX1 in combination with chemotherapy, and possibly other compounds could improve patients’ outcomes.