Speaker: Rodney Infante, Associate Professor, UT Southwestern
Cachexia consists of wasting of muscle and/or adipose, observed in ~50% of all cancer
patients, and associated with 20-30% of all cancer-related deaths. Our clinical studies have
shown that cancer cachexia (CC) correlates with a 50% decrement in median survival (14 m vs
28 m, p<0.001) independent of tumor-directed therapies in lung cancer patients. Though its
adverse impact on survival and quality of life are clear, there are no FDA-approved regimens or
biomarkers that predict which patients will develop and eventually succumb to the wasting
syndrome. To characterize tumor-intrinsic alterations that support NSCLC-associated CC, we
screened 54 patient-derived NSCLC lines injected into immunodeficient mice and identified 17
lines with an unambiguous phenotype of either CC (n=10) or non-CC (n=7) based on fat and
muscle loss and independent of tumor growth kinetics. Whole exome sequencing revealed that
8 of the 10 CC lines, but none of the non-CC lines, possessed mutations in the kinase
STK11/LKB1, a regulator of cellular nutrient energy sensors AMP kinase (AMPK) and AMPK-
related kinases. STK11/LKB1 is mutated in approximately 15% of all NSCLCs. CRISPR/Cas9
silencing of STK11/LKB1 in human NSCLCs converted traditionally non-CC lines into those with
CC-inducing potential when transplanted in vivo. Furthermore, mutational analysis of two
independent cohorts of advanced NSCLC patients identified a concordance between tumor
STK11/LKB1 variants and weight loss at NSCLC diagnosis.
Growth differentiation factor 15 (GDF15) is a stress response cytokine initially made as a
proprotein and subsequently protease-activated and secreted regulating inflammation immune
cell responses, immunotherapy resistance, and metabolism including anorexia. We
demonstrated that STK11/LKB1-mutated NSCLC associates with elevated GDF15, and
surprisingly the source of this GDF15 is from the tumor cells and not from host cells. GDF15
neutralizing antibody administered to mice transplanted with human STK11/LKB1-mutated
NSCLC lines suppressed cachexia-associated adipose loss, muscle atrophy, and changes in
body weight. Silencing of GDF15 expression in human STK11/LKB1-mutated NSCLC lines was
also sufficient to eliminate in vivo circulating GDF15 levels and abrogate cachexia induction,
reinforcing that tumor cells and not host tissues represent a key source of GDF15 production in
these cancer models. Reconstitution of wild-type STK11/LKB1 in human CC-inducing NSCLCs
possessing STK11/LKB1 loss of function variants resulted in the suppression of tumor cell
expression and processing of GDF15 and rescue of the cachexia phenotype. Overall, these
efforts establish 1) STK11/LKB1 as the first genetic biomarker for NSCLC cachexia, 2) Tumor
cell-secreted GDF15 mediates host wasting in STK11/LKB1-mutated NSCLC cachexia, and 3)
Novel understanding of CC mechanisms that are being employed in biomarker-enriched clinical
trials.