Further experimental assays that are being used pre-clinically to detect replicative stress in tumors are shown in Table 4. Table 3 Predictive genomic and epigenetic biomarkers of replicative stress in pre-clinical development or mutationOncogenic Ras expression activates ATR-CHK1 pathway.mutationp53 is phosphorylated and stabilized by ATM/ATR, CHK1/CHK2, and is crucial for the G1 checkpoint. leading to mitotic catastrophe ERK5-IN-1 and cell death. Moreover, the identification of fork protection as a key mechanism of resistance to chemo- and poly (ADP-ribose) polymerase inhibitor therapy in ovarian cancer further increases the priority that should be accorded to the development of strategies targeting replicative stress. Small molecule inhibitors designed to target the DNA damage sensors, such as inhibitors of ataxia telangiectasia-mutated ERK5-IN-1 (ATM), ATR, CHK1 and WEE1, impair easy cell cycle modulation and disrupt efficient DNA repair, or a combination of the above, have exhibited interesting monotherapy and combinatorial activity, including the potential to reverse drug resistance and have joined developmental pipelines. Yet unresolved challenges lie in balancing the toxicity profile of these drugs in order ERK5-IN-1 to achieve a suitable therapeutic index while maintaining clinical efficacy, and selective biomarkers are urgently required. Here we describe the premise for targeting of replicative stress in gynecological cancers and discuss the clinical advancement of this strategy. increases cyclin E levels leading to aberrant firing of the replication origin. Increased activity has links with defective reduction/oxidation balance in cells, and an accumulation of reactive oxygen species which induce replicative stress by the formation of oxidized nucleotides such as 8-oxoguanine, leading to mismatched base pairing.7 Similarly, mutations in gatekeeper tumor suppressor genes that regulate cell cycle checkpoints, such as in and (20%), loss (15%), as well as mutations in (2%) and (2%) are not infrequent.9 Furthermore, is ubiquitously mutated in high grade serous carcinoma, increasing their reliance around the G2/M checkpoint. Targeting cell cycle checkpoints through inhibition of the ATRCCHK1CWEE1 axis may therefore induce synthetic lethality in high grade serous carcinoma cells with oncogenic stress or which harbor intrinsic deficiencies in DNA repair. The increasing number of approvals for PARP inhibitors (PARPis) in advanced ovarian cancer therapy indicates that PARPis are steadily shifting treatment paradigms, heralding an increasing proportion of patients who are at risk of PARPi-resistant disease. PARPi resistance occurs through several independent mechanisms that have been grouped into three categories: (1) mitigation of replication stress by replication fork protection, such as through the loss of mixed-lineage leukemia protein 3/4 (MLL3/4) complex protein Pax2 transactivation domain name interacting protein (PTIP) which prevents MRE11 from being recruited to stalled forks;10 (2) restoration of homologous recombination activity; and (3) processes that do not fall under any single DNA repair pathway but alter the response to PARPi, such as increased drug efflux, loss of PARP1 expression, and down-regulation of PARP trapping capacity.11 In PARPi-resistant but are sequentially bypassed and cells become increasingly dependent on ATR for recruitment of RAD51 onto double-stranded breaks and stalled forks.12 13 Inhibition of ATR using the ATR inhibitor (ATRi) VE-821 in olaparib-resistant amplification, and mutation. overexpression prompts early S-phase entry and increases genomic instability, increasing reliance on homologous recombination DNA repair. mutations occur in ~50% of ovarian and endometrial clear cell carcinoma and ~30% of endometrial cancers of endometrioid and carcinosarcoma subtype. After DNA damage, AT-rich interacting domain name containing protein 1A (ARID1A) assists in non-homologous end-joining (NHEJ) DNA repair by recruiting x-ray repair cross-complementing 5 and 6 (XRCC5/6) to sites of double-stranded breaks, acts as a binding partner of ATR, and sustains DNA damage signaling in response to double-stranded breaks.16 Using genetic screens, Williamson identified as a synthetic lethal partner for ATR inhibition and showed susceptibility to ATRi in a variety of histologically diverse loss Ceralasertib + olaparib Recruitment ongoingN/AATARI;amplification, defined by amplification 7, or found on approved next-generation tumor sequencing panels Adavosertib monotherapy (D1C5 and 8C12), every 21 days Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03253679″,”term_id”:”NCT03253679″NCT03253679II Recurrent ovarian, primary peritoneal, or fallopian tube cancer, who have progressed during PARP inhibition Randomized, non-comparative study Adavosertib (daily D1C5 and 8C12) every 21 days (Arm A) or adavosertib (daily D1C3 and 8C10) + olaparib (twice daily D1C21) every 21 days (Arm B) Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03579316″,”term_id”:”NCT03579316″NCT03579316II Advanced refractory solid tumors harboring mutations in or both Olaparib + adavosertib Active, not recruitingN/AOLAPCO;mutation Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT02203513″,”term_id”:”NCT02203513″NCT02203513II Advanced solid tumors with either amplification, loss or mutation; homologous recombination repair deficiency or CCNE1 amplification Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days. Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days Active, not recruitingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT02873975″,”term_id”:”NCT02873975″NCT02873975I Advanced solid tumors, including patients who have previously been treated with a PARPi Prexasertib + olaparib Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03057145″,”term_id”:”NCT03057145″NCT03057145I Advanced solid tumors Prexasertib + LY3300054 (novel PD-L1 inhibitor) Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03495323″,”term_id”:”NCT03495323″NCT03495323SRA737I/II Advanced HGSOC, cervical/anogenital cancers, soft tissue sarcoma or small cell lung cancer with genomic alterations (and phosphorylation.23 In ovarian cancer, WEE1 was found to be overexpressed in 92% of effusions from advanced high grade serous carcinoma,24 and expression was significantly higher in chemotherapy-refractory compared with treatment-naive patients. High WEE1 expression correlated independently.Increased activity has links with defective reduction/oxidation balance in cells, and an accumulation of reactive oxygen species which induce replicative stress by the formation of oxidized nucleotides such as 8-oxoguanine, leading to mismatched base pairing.7 Similarly, mutations in gatekeeper tumor suppressor genes that regulate cell cycle checkpoints, such as in and (20%), loss (15%), as well as mutations in (2%) and (2%) are not infrequent.9 Furthermore, is ubiquitously mutated in high grade serous carcinoma, increasing their reliance around the G2/M checkpoint. of the above, have exhibited interesting monotherapy and combinatorial activity, including the potential to reverse drug resistance and have entered developmental pipelines. Yet unresolved challenges lie in balancing the toxicity profile of these drugs in order to achieve a suitable therapeutic index while maintaining clinical efficacy, and selective biomarkers are urgently required. Here we describe the premise for targeting of replicative stress in gynecological cancers and discuss the clinical advancement of this strategy. increases cyclin E levels leading to aberrant firing of the replication origin. Increased activity has links with defective reduction/oxidation balance in cells, and an accumulation of reactive oxygen species which induce replicative stress by the formation of oxidized nucleotides such as 8-oxoguanine, leading to mismatched base pairing.7 Similarly, mutations in gatekeeper tumor suppressor genes that regulate cell cycle checkpoints, such as in and (20%), loss (15%), as well as mutations in (2%) and (2%) are not infrequent.9 Furthermore, is ubiquitously mutated in high grade serous carcinoma, increasing their reliance on the G2/M checkpoint. Targeting cell cycle checkpoints through inhibition of the ATRCCHK1CWEE1 axis may therefore induce synthetic lethality in ERK5-IN-1 high grade serous carcinoma cells with oncogenic stress or which harbor intrinsic deficiencies in DNA repair. The increasing number of approvals for PARP inhibitors (PARPis) in advanced ovarian cancer therapy indicates that PARPis are steadily shifting treatment paradigms, heralding an increasing proportion of patients who are at risk of PARPi-resistant disease. PARPi resistance occurs through several independent mechanisms that have been grouped into three categories: (1) mitigation of replication stress by replication fork protection, such as through the loss of mixed-lineage leukemia protein 3/4 (MLL3/4) complex protein Pax2 transactivation domain interacting protein (PTIP) which prevents MRE11 from being recruited to stalled forks;10 (2) restoration of homologous recombination activity; and (3) processes that do not fall under any single ERK5-IN-1 DNA repair pathway but alter the response to PARPi, such as increased drug efflux, loss of PARP1 expression, and down-regulation of PARP trapping capacity.11 In PARPi-resistant but are sequentially bypassed and cells become increasingly dependent on ATR for recruitment of RAD51 onto double-stranded breaks and stalled forks.12 13 Inhibition of ATR using the ATR inhibitor (ATRi) VE-821 in olaparib-resistant amplification, and mutation. overexpression prompts early S-phase entry and increases genomic instability, increasing reliance on homologous recombination DNA repair. mutations occur in ~50% of ovarian and endometrial clear cell carcinoma and ~30% of endometrial cancers of endometrioid and carcinosarcoma subtype. After DNA damage, AT-rich interacting domain containing protein 1A (ARID1A) assists in non-homologous end-joining (NHEJ) DNA repair by recruiting x-ray repair cross-complementing 5 and 6 (XRCC5/6) to sites of double-stranded breaks, acts as a binding partner of ATR, and sustains DNA damage signaling in response to double-stranded breaks.16 Using genetic screens, Williamson identified as a synthetic lethal partner for ATR inhibition and showed susceptibility to ATRi in a variety of histologically diverse loss Ceralasertib + olaparib Recruitment ongoingN/AATARI;amplification, defined by amplification 7, or found on approved next-generation tumor sequencing panels Adavosertib monotherapy (D1C5 and 8C12), every 21 days Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03253679″,”term_id”:”NCT03253679″NCT03253679II Recurrent ovarian, primary peritoneal, or fallopian tube cancer, who have progressed during PARP inhibition Randomized, non-comparative study Adavosertib (daily D1C5 and 8C12) every 21 days (Arm A) or adavosertib (daily D1C3 and 8C10) + olaparib (twice daily D1C21) every 21 days (Arm B) Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03579316″,”term_id”:”NCT03579316″NCT03579316II Advanced refractory solid tumors harboring mutations in or both Olaparib + adavosertib Active, not recruitingN/AOLAPCO;mutation Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT02203513″,”term_id”:”NCT02203513″NCT02203513II Advanced solid tumors with either amplification, loss or mutation; homologous recombination repair deficiency or CCNE1 amplification Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days. Prexasertib monotherapy (105?mg/m2 D1 and 15), every 28 days Active, not recruitingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT02873975″,”term_id”:”NCT02873975″NCT02873975I Advanced solid tumors, including patients who have previously been treated with a PARPi Prexasertib + olaparib Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03057145″,”term_id”:”NCT03057145″NCT03057145I Advanced solid tumors Prexasertib + LY3300054 (novel PD-L1 inhibitor) Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03495323″,”term_id”:”NCT03495323″NCT03495323SRA737I/II.Small molecule inhibitors designed to target the DNA damage sensors, such as inhibitors of ataxia telangiectasia-mutated (ATM), ATR, CHK1 and WEE1, impair smooth cell cycle modulation and disrupt efficient DNA repair, or a combination of the above, have demonstrated interesting monotherapy and combinatorial activity, including the potential to reverse drug resistance and have entered developmental pipelines. that should be accorded to the development of strategies targeting replicative stress. Small molecule inhibitors designed to target the DNA damage sensors, such as inhibitors of ataxia telangiectasia-mutated (ATM), ATR, CHK1 and WEE1, impair smooth cell cycle modulation and disrupt efficient DNA repair, or a combination of the above, have demonstrated interesting monotherapy and combinatorial activity, including the potential to reverse drug resistance and have entered developmental pipelines. Yet unresolved challenges lie in balancing the toxicity profile of these drugs in order to achieve a suitable therapeutic index while maintaining clinical efficacy, and selective biomarkers are urgently required. Here we describe the premise for targeting of replicative stress in gynecological cancers and discuss the clinical advancement of this strategy. increases cyclin E levels leading to aberrant firing of the replication origin. Increased activity has links with defective reduction/oxidation balance in cells, and an accumulation of reactive oxygen species which induce replicative stress by the formation of oxidized nucleotides such as 8-oxoguanine, leading to mismatched base pairing.7 Similarly, mutations in gatekeeper tumor suppressor genes that regulate cell cycle checkpoints, such as in and (20%), loss (15%), as well as mutations in (2%) and (2%) are not infrequent.9 Furthermore, is ubiquitously mutated in high grade serous carcinoma, increasing their reliance within the G2/M checkpoint. Focusing on cell cycle checkpoints through inhibition of the ATRCCHK1CWEE1 axis may consequently induce synthetic lethality in high grade serous carcinoma cells with oncogenic stress or which harbor intrinsic deficiencies in DNA restoration. The increasing quantity of approvals for PARP inhibitors (PARPis) in advanced ovarian malignancy therapy shows that PARPis are continuously shifting treatment paradigms, heralding an increasing proportion of individuals who are at risk of PARPi-resistant disease. PARPi resistance occurs through several independent mechanisms that have been grouped into three groups: (1) mitigation of replication stress by replication fork safety, such as through the loss of mixed-lineage leukemia protein 3/4 (MLL3/4) complex protein Pax2 transactivation website interacting protein (PTIP) which helps prevent MRE11 from becoming recruited to stalled forks;10 (2) restoration of homologous recombination activity; and (3) processes that do not fall under any solitary DNA restoration pathway but alter the response to PARPi, such as increased drug efflux, loss of PARP1 manifestation, and down-regulation of PARP trapping capacity.11 In PARPi-resistant but are sequentially bypassed and cells become increasingly dependent on ATR for recruitment of RAD51 onto double-stranded breaks and stalled forks.12 13 Inhibition of ATR using the ATR inhibitor (ATRi) VE-821 in olaparib-resistant amplification, and mutation. overexpression prompts early S-phase access and raises genomic instability, increasing reliance on homologous recombination DNA restoration. mutations happen in ~50% of ovarian and endometrial obvious cell carcinoma and ~30% of endometrial cancers of endometrioid and carcinosarcoma subtype. After DNA damage, AT-rich interacting website containing protein 1A (ARID1A) aids in non-homologous end-joining (NHEJ) DNA restoration by recruiting x-ray restoration cross-complementing 5 and 6 (XRCC5/6) to sites of double-stranded breaks, functions as a binding partner of ATR, and sustains DNA damage signaling in response to double-stranded breaks.16 Using genetic screens, Williamson identified as a synthetic lethal partner for ATR MDS1-EVI1 inhibition and showed susceptibility to ATRi in a variety of histologically diverse loss Ceralasertib + olaparib Recruitment ongoingN/AATARI;amplification, defined by amplification 7, or found on approved next-generation tumor sequencing panels Adavosertib monotherapy (D1C5 and 8C12), every 21 days Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03253679″,”term_id”:”NCT03253679″NCT03253679II Recurrent ovarian, main peritoneal, or fallopian tube cancer, who have progressed during PARP inhibition Randomized, non-comparative study Adavosertib (daily D1C5 and 8C12) every 21 days (Arm A) or adavosertib (daily D1C3 and 8C10) + olaparib (twice daily D1C21) every 21 days (Arm B) Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03579316″,”term_id”:”NCT03579316″NCT03579316II.The amount of DNA tails directly correlates with the percentage of DNA damage 2 Patient derived organoidsHill and colleagues developed 33 patient-derived organoid ethnicities from individuals with HGSOC and tested them for HR problems, as well as replication fork safety. activity, including the potential to reverse drug resistance and have came into developmental pipelines. Yet unresolved challenges lay in managing the toxicity profile of these drugs in order to achieve a suitable restorative index while keeping clinical effectiveness, and selective biomarkers are urgently required. Here we describe the premise for focusing on of replicative stress in gynecological cancers and discuss the medical advancement of this strategy. raises cyclin E levels leading to aberrant firing of the replication source. Increased activity offers links with defective reduction/oxidation balance in cells, and an accumulation of reactive oxygen species which induce replicative stress by the formation of oxidized nucleotides such as 8-oxoguanine, leading to mismatched foundation pairing.7 Similarly, mutations in gatekeeper tumor suppressor genes that regulate cell cycle checkpoints, such as in and (20%), loss (15%), as well as mutations in (2%) and (2%) are not infrequent.9 Furthermore, is ubiquitously mutated in high grade serous carcinoma, increasing their reliance within the G2/M checkpoint. Focusing on cell cycle checkpoints through inhibition of the ATRCCHK1CWEE1 axis may consequently induce synthetic lethality in high grade serous carcinoma cells with oncogenic stress or which harbor intrinsic deficiencies in DNA restoration. The increasing quantity of approvals for PARP inhibitors (PARPis) in advanced ovarian malignancy therapy shows that PARPis are continuously shifting treatment paradigms, heralding an increasing proportion of individuals who are at risk of PARPi-resistant disease. PARPi resistance occurs through several independent mechanisms that have been grouped into three groups: (1) mitigation of replication stress by replication fork safety, such as through the loss of mixed-lineage leukemia protein 3/4 (MLL3/4) complex protein Pax2 transactivation website interacting protein (PTIP) which helps prevent MRE11 from becoming recruited to stalled forks;10 (2) restoration of homologous recombination activity; and (3) processes that do not fall under any solitary DNA restoration pathway but alter the response to PARPi, such as increased drug efflux, loss of PARP1 manifestation, and down-regulation of PARP trapping capacity.11 In PARPi-resistant but are sequentially bypassed and cells become increasingly dependent on ATR for recruitment of RAD51 onto double-stranded breaks and stalled forks.12 13 Inhibition of ATR using the ATR inhibitor (ATRi) VE-821 in olaparib-resistant amplification, and mutation. overexpression prompts early S-phase access and raises genomic instability, increasing reliance on homologous recombination DNA restoration. mutations happen in ~50% of ovarian and endometrial obvious cell carcinoma and ~30% of endometrial cancers of endometrioid and carcinosarcoma subtype. After DNA damage, AT-rich interacting website containing protein 1A (ARID1A) aids in non-homologous end-joining (NHEJ) DNA restoration by recruiting x-ray restoration cross-complementing 5 and 6 (XRCC5/6) to sites of double-stranded breaks, functions as a binding partner of ATR, and sustains DNA harm signaling in response to double-stranded breaks.16 Using genetic displays, Williamson defined as a man made lethal partner for ATR inhibition and demonstrated susceptibility to ATRi in a number of histologically diverse reduction Ceralasertib + olaparib Recruitment ongoingN/AATARI;amplification, defined by amplification 7, or entirely on approved next-generation tumor sequencing sections Adavosertib monotherapy (D1C5 and 8C12), every 21 times Recruitment ongoingN/A”type”:”clinical-trial”,”attrs”:”text”:”NCT03253679″,”term_id”:”NCT03253679″NCT03253679IWe Recurrent ovarian, major peritoneal, or fallopian pipe cancer, who’ve progressed during PARP inhibition Randomized, non-comparative research Adavosertib (daily D1C5 and 8C12) every 21 times.