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Translating Genomes | Personalizing Medicine 
Using cell-based assays in the development of efficacious cancer therapies 
Dr. Kyla Grimshaw 
VP Research Operations
2 
Presenter 
Kyla Grimshaw PhD 
VP Research Operations 
Kyla has been leading the oncology translational research service at Horizon 
since co-founding the CRO arm of the company in 2007. 
Prior to this, she worked on multiple drug discovery programmes at 
Millennium Pharmaceuticals and Astex Pharmaceuticals. 
Her core area of expertise is in oncology cell biology and providing expert 
contract research to customers.
3 
Content of the Presentation 
 Introduction to Horizon Discovery 
 Horizon Discovery Research Division - Horizon’s services and collaboration platforms 
 Applying cell-based assays to address key questions in cancer drug discovery 
• Use of isogenic cell lines 
• Compound vs. genetic knockdown studies 
• Tumour microenvironment 
• Combination assays 
 New developments 
 Summary
Translating genetic information into personalised medicine 
Genomics Translational Genomics Personalised Medicine 
4
Horizon is a Products & Services Company 
5
Genome Editing: To create accurate genetic models 
Isakoff et al., Cancer Research, Jan 2006 Di Nicolantonio et al., PNAS, Dec. 2008 
6 
 Large growth induction phenotype 
 Transforming alone 
 Milder growth induction phenotype 
 Non-transforming alone
Genome Editing: To translate in vitro discoveries to patient treatments 
 All K-RAS mutant patients excluded from therapy with Erbitux® EGFR targeted agent 
 X-MAN™ lines predicted Erbitux® may work for a 20% sub-set of these patients with G13D, 
7 
new trials on-going 
In vitro cell models In vivo xenograft models Patient clinical trials
Horizon Discovery Research Division: Horizon’s services and collaboration 
platforms 
8 
 Tool 1: X-MAN™ Cell Lines 
• Patient stratification 
• Target validation 
• Pathway interrogation 
 Tool 2: Tumour Microenvironment 
• 3D assays 
• Co-culture 
• Hypoxia, nutrient starvation 
 Tool 3: Screening Platforms 
• siRNA 
• shRNA 
• sgRNA 
 Plus all functional assays typical of oncology drug discovery programmes
Horizon Discovery Research Division: Horizon’s services and collaboration 
platforms 
9 
 Tool 1: X-MAN Cell Lines 
• Patient stratification 
• Target validation 
• Pathway interrogation 
 Tool 2: Tumour Microenvironment 
• 3D assays 
• Co-culture 
• Hypoxia, nutrient starvation 
 Tool 3: Screening Platforms 
• siRNA 
• shRNA 
• sgRNA 
CombinatoRx platform 
In vivo platform 
 Plus all functional assays typical of oncology drug discovery programmes
Key Questions: Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy?
Target Validation: Use of Knock-down, Knock-out and Knock-in experiments 
shRNA target knock-down in A549 cells sgRNA target knock-out in A549 cells 
900 
800 
700 
600 
500 
400 
300 
200 
100 
0 
HCT116 WT HCT116 
KO 
0 6 12 18 24 30 
11 
Knock-out of gene, in vivo 
Tumour Volume (mm3) 
Time (days) 
Knock-in of activity dead 
mutation, in 3D
Target Validation: A new Target Essentiality Analysis 
Infect cells targeting gene of interest 
Cas9 nuclease activity will introduce 
random double strand breaks into 
each allele of the target cell line. 
Culture colonies from single cells 
Assess length of fluorescent PCR 
products to check allele ratios and 
frame shift occurrence in 100’s 
colonies 
TARGET ESSENTIAL 
Colonies contain only in 
frame indels 
TARGET NON-ESSENTIAL 
Colonies contain frame 
shift indels
Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy?
14 
Isogenic cell lines 
 Horizon has collection of over 550 isogenic cell line pairs  X-MAN™ cell lines 
 Horizon’s expert targeting team can also engineer a genetically validated cell line to a 
customer’s specification
Patient stratification: Isogenic cell line panel screening - genotype ID 
15
Target identification using synthetic lethality screening and isogenic cell lines 
 Precisely control for target genotype and perfectly matched ‘normal’ 
 Removes a key source of noise in synthetic lethality screens 
16 
 siRNA target ID 
Synthetic lethality waterfall plot (HCT116 isogenics) 
Hits with selective death in the 
mutant line
Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy?
Resistance to a tyrosine kinase inhibitor is conferred by PTEN deletion or 
activating mutations of PIK3CA in colon cancer cells 
Cell viability
Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy?
Effect of assay format on Olaparib response in DLD-1 colorectal cancer cells 
96 h proliferation assay 10 day colony formation assay
Effect of oxygen levels on Tirapazamine response in HCT116 cells 
3D spheroid 
Pimonidazole staining of 
spheroid cross-section
Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy?
3D conditions reveal a dependence on oncogenic KRAS in colon cancer cells 
2D Adherent 3D Soft Agar 
DLD-1 KRASG13D 
DLD-1 KRASG13D KO 
siRNA to KRAS in 3D 
Response to MEK inhibitors in 2D vs. 3D 
Log [M] ARRY162 (MEK inhibitor)
Cell-Based Assays in Cancer Drug and Target Discovery 
Is the target well validated? 
Which patients should I target? 
Which patients should I avoid? 
Is my assay configured correctly? 
Impact of tumour microenvironment 
What about combination therapy
High throughput cell-based drug combination assays 
Diverse Mutational 
Backgrounds 
Compounds 
Compounds 
Function 1 
Function 2 
Function 3 
Function 4 
Function 5 
Function 6 
Function 7 
Function 8 
Function 9 
Function 10 
Function 11 
Function 12 
Function 13 
Function 14 
Function 15 
Function 16 
Function 17 
Function 18 
Function 19 
Function 20 
Function 21 
Function 22 
Function 23 
Function 24 
Function 25 
Function 26 
Function 1 
Function 2 
Function 3 
Function 4 
Function 5 
Function 6 
Function 7 
Function 8 
Function 9 
Function 10 
Function 11 
Function 12 
Function 13 
Function 14 
Function 15 
Function 16 
Function 17 
Function 18 
Function 19 
Function 20 
Function 21 
Function 22 
Function 23 
Function 24 
Function 25 
Function 26 
 Over 800 cell lines 
 250 enhancer agents 
 Over a decade of experience in drug combination screening 
Measured Activities Excess
Horizon Discovery: Integrated Solutions 
Single agent 
100-400 cancer cell lines 
Combination study 
100-400 cancer cell lines 
100+ enhancers 
HIT NOMINATION 
Isogenic Cell Lines 
Model generation 
AAV/CRISPR/ZFN 
PDX models 
ex-vivo, in vivo 
Highly characterised 
26 
Secondary assays 
Microenvironment, 
scheduling, higher order 
combinations 
MOA interrogation 
siRNA/sgRNA/shRNA 
Biomarkers assessment 
Isogenic panels 
Gene expression analysis 
For MOA insights and PD 
marker direction 
In vivo KO models 
Genetic engineering in 
rat or mouse models 
ZFN/CRISPR 
Xenograft models 
Standard mouse 
xenografts 
Bioinformatics Analysis 
Response predictors, 
clustering 
Isogenic cell lines 
Model generation, 
screening in directed panels
Recent New Developments: New Assay Models 
HaloTag® NanoLuc™ 
27 
 Endogenous reporter cell lines and kits 
• X-MAN™ HaloTag® Reporter Kits 
 Knock-in of reporters/tag into endogenous locus for in vitro imaging / pull-downs / 
purification 
• X-MAN™ NanoLuc™ Reporter Kits 
 Knock-in of Luciferase reporter into endogenous locus for in vitro & in vivo pathway read-outs 
TMR ligand DNA Stain
Recent New Developments: New Assay Models 
28 
 PDX models 
• 25 PDX models of breast cancer, characterised by whole genome 
sequencing 
• WGS has also been performed on the originating tumors, early and 
late passages of PDX, as well as metastases, demonstrating striking 
similarity and faithful modelling of the original tumor by WHIM PDX 
models. 
 iPS organoids 
• Currently under development 
Maintenance of 
undifferentiated iPS cells 
Differentiation into 
human endoderm 
Differentiation into human mid/hind gut 
Growing mid/hind gut 
spheroids into human 
intestinal organoids
Recent New Developments: Synthetic Lethal Target ID via sgRNA Screening 
Webinar: RNA-based screening in drug discovery – introducing sgRNA technologies 
Tue 9th Dec at 4 pm (GMT) 
29 
Shalem et al Science 2014
Repositioning 
Patient 
stratification 
Working with Horizon Services Division 
Target ID Target Validation H2L LO 
Generation of isogenic cell lines MOA assays to support med chem 
siRNA screens 
sgRNA screens 
TIDVAL alliances 
KO to test 
essentiality 
Activity dead KI 
mutations 
Compound profiling in 
isogenic cells 
Compound profiling in large 
Combination assays 
cell line panels 
Target validation & early stage drug discovery 
collaborations 
Finding a development path for 
stranded clinical assets 
In vivo models 
30 
Discovery Research 
Services 
Custom Cell Line 
Development 
CombinatoRx 
Custom Screening 
Services 
In vivo models
Your Horizon Contact: 
Dr. Kyla Grimshaw 
VP Research Operations 
k.grimshaw@horizondiscovery.com 
+44 (0)1223 655580 
Horizon Discovery Ltd, Building 7100, Cambridge Research Park, Waterbeach, Cambridge, CB25 9TL, United Kingdom 
Tel: +44 (0) 1223 655 580 (Reception / Front desk) Fax: +44 (0) 1223 862 240 Email: info@horizondiscovery.com Web: 
www.horizondiscovery.com

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Translating Genomes | Personalizing Medicine

  • 1. Translating Genomes | Personalizing Medicine Using cell-based assays in the development of efficacious cancer therapies Dr. Kyla Grimshaw VP Research Operations
  • 2. 2 Presenter Kyla Grimshaw PhD VP Research Operations Kyla has been leading the oncology translational research service at Horizon since co-founding the CRO arm of the company in 2007. Prior to this, she worked on multiple drug discovery programmes at Millennium Pharmaceuticals and Astex Pharmaceuticals. Her core area of expertise is in oncology cell biology and providing expert contract research to customers.
  • 3. 3 Content of the Presentation  Introduction to Horizon Discovery  Horizon Discovery Research Division - Horizon’s services and collaboration platforms  Applying cell-based assays to address key questions in cancer drug discovery • Use of isogenic cell lines • Compound vs. genetic knockdown studies • Tumour microenvironment • Combination assays  New developments  Summary
  • 4. Translating genetic information into personalised medicine Genomics Translational Genomics Personalised Medicine 4
  • 5. Horizon is a Products & Services Company 5
  • 6. Genome Editing: To create accurate genetic models Isakoff et al., Cancer Research, Jan 2006 Di Nicolantonio et al., PNAS, Dec. 2008 6  Large growth induction phenotype  Transforming alone  Milder growth induction phenotype  Non-transforming alone
  • 7. Genome Editing: To translate in vitro discoveries to patient treatments  All K-RAS mutant patients excluded from therapy with Erbitux® EGFR targeted agent  X-MAN™ lines predicted Erbitux® may work for a 20% sub-set of these patients with G13D, 7 new trials on-going In vitro cell models In vivo xenograft models Patient clinical trials
  • 8. Horizon Discovery Research Division: Horizon’s services and collaboration platforms 8  Tool 1: X-MAN™ Cell Lines • Patient stratification • Target validation • Pathway interrogation  Tool 2: Tumour Microenvironment • 3D assays • Co-culture • Hypoxia, nutrient starvation  Tool 3: Screening Platforms • siRNA • shRNA • sgRNA  Plus all functional assays typical of oncology drug discovery programmes
  • 9. Horizon Discovery Research Division: Horizon’s services and collaboration platforms 9  Tool 1: X-MAN Cell Lines • Patient stratification • Target validation • Pathway interrogation  Tool 2: Tumour Microenvironment • 3D assays • Co-culture • Hypoxia, nutrient starvation  Tool 3: Screening Platforms • siRNA • shRNA • sgRNA CombinatoRx platform In vivo platform  Plus all functional assays typical of oncology drug discovery programmes
  • 10. Key Questions: Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy?
  • 11. Target Validation: Use of Knock-down, Knock-out and Knock-in experiments shRNA target knock-down in A549 cells sgRNA target knock-out in A549 cells 900 800 700 600 500 400 300 200 100 0 HCT116 WT HCT116 KO 0 6 12 18 24 30 11 Knock-out of gene, in vivo Tumour Volume (mm3) Time (days) Knock-in of activity dead mutation, in 3D
  • 12. Target Validation: A new Target Essentiality Analysis Infect cells targeting gene of interest Cas9 nuclease activity will introduce random double strand breaks into each allele of the target cell line. Culture colonies from single cells Assess length of fluorescent PCR products to check allele ratios and frame shift occurrence in 100’s colonies TARGET ESSENTIAL Colonies contain only in frame indels TARGET NON-ESSENTIAL Colonies contain frame shift indels
  • 13. Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy?
  • 14. 14 Isogenic cell lines  Horizon has collection of over 550 isogenic cell line pairs  X-MAN™ cell lines  Horizon’s expert targeting team can also engineer a genetically validated cell line to a customer’s specification
  • 15. Patient stratification: Isogenic cell line panel screening - genotype ID 15
  • 16. Target identification using synthetic lethality screening and isogenic cell lines  Precisely control for target genotype and perfectly matched ‘normal’  Removes a key source of noise in synthetic lethality screens 16  siRNA target ID Synthetic lethality waterfall plot (HCT116 isogenics) Hits with selective death in the mutant line
  • 17. Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy?
  • 18. Resistance to a tyrosine kinase inhibitor is conferred by PTEN deletion or activating mutations of PIK3CA in colon cancer cells Cell viability
  • 19. Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy?
  • 20. Effect of assay format on Olaparib response in DLD-1 colorectal cancer cells 96 h proliferation assay 10 day colony formation assay
  • 21. Effect of oxygen levels on Tirapazamine response in HCT116 cells 3D spheroid Pimonidazole staining of spheroid cross-section
  • 22. Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy?
  • 23. 3D conditions reveal a dependence on oncogenic KRAS in colon cancer cells 2D Adherent 3D Soft Agar DLD-1 KRASG13D DLD-1 KRASG13D KO siRNA to KRAS in 3D Response to MEK inhibitors in 2D vs. 3D Log [M] ARRY162 (MEK inhibitor)
  • 24. Cell-Based Assays in Cancer Drug and Target Discovery Is the target well validated? Which patients should I target? Which patients should I avoid? Is my assay configured correctly? Impact of tumour microenvironment What about combination therapy
  • 25. High throughput cell-based drug combination assays Diverse Mutational Backgrounds Compounds Compounds Function 1 Function 2 Function 3 Function 4 Function 5 Function 6 Function 7 Function 8 Function 9 Function 10 Function 11 Function 12 Function 13 Function 14 Function 15 Function 16 Function 17 Function 18 Function 19 Function 20 Function 21 Function 22 Function 23 Function 24 Function 25 Function 26 Function 1 Function 2 Function 3 Function 4 Function 5 Function 6 Function 7 Function 8 Function 9 Function 10 Function 11 Function 12 Function 13 Function 14 Function 15 Function 16 Function 17 Function 18 Function 19 Function 20 Function 21 Function 22 Function 23 Function 24 Function 25 Function 26  Over 800 cell lines  250 enhancer agents  Over a decade of experience in drug combination screening Measured Activities Excess
  • 26. Horizon Discovery: Integrated Solutions Single agent 100-400 cancer cell lines Combination study 100-400 cancer cell lines 100+ enhancers HIT NOMINATION Isogenic Cell Lines Model generation AAV/CRISPR/ZFN PDX models ex-vivo, in vivo Highly characterised 26 Secondary assays Microenvironment, scheduling, higher order combinations MOA interrogation siRNA/sgRNA/shRNA Biomarkers assessment Isogenic panels Gene expression analysis For MOA insights and PD marker direction In vivo KO models Genetic engineering in rat or mouse models ZFN/CRISPR Xenograft models Standard mouse xenografts Bioinformatics Analysis Response predictors, clustering Isogenic cell lines Model generation, screening in directed panels
  • 27. Recent New Developments: New Assay Models HaloTag® NanoLuc™ 27  Endogenous reporter cell lines and kits • X-MAN™ HaloTag® Reporter Kits  Knock-in of reporters/tag into endogenous locus for in vitro imaging / pull-downs / purification • X-MAN™ NanoLuc™ Reporter Kits  Knock-in of Luciferase reporter into endogenous locus for in vitro & in vivo pathway read-outs TMR ligand DNA Stain
  • 28. Recent New Developments: New Assay Models 28  PDX models • 25 PDX models of breast cancer, characterised by whole genome sequencing • WGS has also been performed on the originating tumors, early and late passages of PDX, as well as metastases, demonstrating striking similarity and faithful modelling of the original tumor by WHIM PDX models.  iPS organoids • Currently under development Maintenance of undifferentiated iPS cells Differentiation into human endoderm Differentiation into human mid/hind gut Growing mid/hind gut spheroids into human intestinal organoids
  • 29. Recent New Developments: Synthetic Lethal Target ID via sgRNA Screening Webinar: RNA-based screening in drug discovery – introducing sgRNA technologies Tue 9th Dec at 4 pm (GMT) 29 Shalem et al Science 2014
  • 30. Repositioning Patient stratification Working with Horizon Services Division Target ID Target Validation H2L LO Generation of isogenic cell lines MOA assays to support med chem siRNA screens sgRNA screens TIDVAL alliances KO to test essentiality Activity dead KI mutations Compound profiling in isogenic cells Compound profiling in large Combination assays cell line panels Target validation & early stage drug discovery collaborations Finding a development path for stranded clinical assets In vivo models 30 Discovery Research Services Custom Cell Line Development CombinatoRx Custom Screening Services In vivo models
  • 31. Your Horizon Contact: Dr. Kyla Grimshaw VP Research Operations k.grimshaw@horizondiscovery.com +44 (0)1223 655580 Horizon Discovery Ltd, Building 7100, Cambridge Research Park, Waterbeach, Cambridge, CB25 9TL, United Kingdom Tel: +44 (0) 1223 655 580 (Reception / Front desk) Fax: +44 (0) 1223 862 240 Email: info@horizondiscovery.com Web: www.horizondiscovery.com

Notes de l'éditeur

  1. Welcome and thank you for joining me today to talk about cell-based assays at Horizon Discovery. In the webinar today I would like to introduce you to Horizon Discovery and describe our functional assays division Focussing on how we use cell based assays to aid our customers and collaborators to perform first class oncology drug discovery.
  2. Information is no longer a bottleneck, emphasis is shifting to the ‘what does it all mean’ Genome editing is enabling the promise of the genomic era to be realized in the form of novel therapeutics and diagnostics It involves the capability to efficiently introduce targeted alterations into any specific gene in living cells
  3. Horizon offers a range of products & services to support this discovery pipeline, from basic research through to validated therapeutic targets. At Horizon, cell line models can be accessed by multiple routes to suit your requirements. Previously created isogenic cell lines can be accessed via our range of of-the-shelf cell lines, or else we can provide reagents and design advice via the GenAssist service through to a full custom cell line development project, generating your specific mutation in the cell line of your choice, performed by Horizons experienced scientists. Target discovery and drug development services now include our high throughput CombinatoRx platform, and in vivo models at our Sage labs facility. These services can be accessed individually or in as an integrated project to enable us to support projects of any size.
  4. Horizon is founded on the use of genome editing, and this is fundamental to our philosophy supporting oncology drug discovery. And here’s why: Historically, to understand the effect of a specific mutation, classic overexpression studies have been performed, in which a mutated gene of interest is introduced randomly into the cell under the control of an exogenous promoter. This can result in unclear results due to the non-physiological levels of expression and regulation. For example, on the slides we can see two studies investigating the effect of the same mutations. The first overexpresses PI3Kinase mutations and resulted in an oncogenic phenotype. However, when these same mutations are introduced into the endogenous PI3K gene, where physiological levels of expression and endogenous mechanisms of regulation are retained, a much milder growth phenotype is observed which alone would not be considered as transforming. This more accurate modelling of the impact of specific mutations enables the multifactoral genotypes present if complex disease to be investigated with greater confidence. Similar limitations can be seen with si and sh RNA studies which attempt to knock-down the expression of genes of interest. However these are rarely complete knockdowns and the residual expression cannot be discounted. Whereas permanent, stable disruption of a gene removes such confounding issues.
  5. We have devised a medium-throughput method that can shed light on the ambiguous results that emerge from siRNA/shRNA or sgRNA screens shRNA only gives partial knockdown; growth phenotypes often partial too Repair of Cas9-mediated ds breaks can result in in-frame indels that don’t disrupt protein function We would use lentiviruses to deliver Cas9 + sgRNA vs target to cells, allow 14-20 days for gene editing to occur and then culture colonies from single cells Horizon’s cell-line engineering experience allows us to devise an analysis pipeline to characterise editing events on a clonal level
  6. Three technical replicates per screen (CVs liquid handling  <2.5%; CVs +/- controls ~ 13%) Blue line is the median parental response plotted as a 2D waterfall Green data points are the mutant response for the matching target gene
  7. 96h reveals some sensitivity to BRACS null lines. 10 day colony forming assay definitively demonstrates.
  8. In a 2D cell culture assay tirapazamine requires exposure to low oxygen conditions for activation and to exert anti-proliferative effects. Activity is seen in a 3D spheroid model which contains a hypoxic core Cell line?
  9. Finally, An exciting new area that is gaining a lot of interest at the moment are endogenous reporter lines. The same limitations that apply to over-expression studies apply to systems employigg synthetic reporter systems. In collaboration with Promega we have generated panels of cell lines that contain genes endogenously tagged with either the multi-purpose Halo-Tag or Nano Luc – an extremely bright reporter, over 150x as bright as standard firefly luciferase using this technology, it is now possible to monitor the regulation of gene expression at the endogenous level and are sutiable for use in high-throughput formats.
  10. And we are also investing in more complex disease models in the form of both PDX and organoids. Though Sage labs we have developed 25 breast cancer PDX models. These are one of the most characterised sources of breast PDX models in the world, and are currently being established in our labs. And we are also very interested to explore the possibilities of growing iPS organoids, both for screening and cell line engineering purposes .The data shown here is from our labs where we are at the exciting stage of sectioning fully formed organoids.
  11. And if you would like to hear more about this exciting new area, please register for our sgRNA screening webinar n the 9th Dec. Cancer is a genetic disease Genome sequencing has generated 100’s of potential targets for cancer therapy However, most targets are rare and poorly characterised Most of them can’t be drugged directly e.g., tumour suppressors If tumour suppressor loss is the prime cancer initiating event, agents exploiting this loss may assist with overcoming tumour heterogeneity Systematic de-orphaning required to find key druggable downstream targets - exploiting co-dependence or synthetic lethality
  12. Additional slide options