Article
Author: Di Francesco, M. Emilia  ; Holla, Vijaykumar  ; Smith, Graeme C.M.  ; Lazar, Alexander J.  ; Shaw, Kenna Rael  ; Sanchez, Nora S.  ; Lillo, Giorgia  ; Yap, Timothy A.  ; Marszalek, Joseph R.  ; Liu, Chiu-Yi  ; Tse, Wai Yiu  ; Carroll, Christopher L.  ; Gheeya, Jinesh S.  ; Giuliani, Virginia  ; Le, Hung  ; Machado, Annette A.  ; Piscitello, Desiree  ; Kyewalabye, Keith  ; McGrail, Daniel J.  ; Elinati, Elias  ; Geck Do, Mary K.  ; Wani, Khalida M.  ; Vellano, Christopher P.  ; Grinkevich, Vera  ; Yang, Dong  ; Feng, Ningping  ; Geo, Lerin  ; Kopetz, Scott E.  ; Johnson, Michael G.  ; Goswamy, Rohit Vivek  ; Johnson, Timothy I.  ; Majithiya, Jayesh  ; Armstrong, Lucy  ; Pilié, Patrick G.  ; Ranzani, Marco  ; Neves, Joana  ; Heffernan, Timothy P.  ; Jones, Philip  ; Robinson, Helen M.R.  ; Wang, Wei-Lien  ; Rajendra, Eeson  ; Lively, Sarah  ; Bristow, Christopher A.  ; Campbell, Erick  ; Bardenhagen, Jennifer P.  ; Ma, XiaoYan  ; Luzarraga, Marina Roy  ; Boursier, Marie  ; Ngoi, Natalie Y.L.  ; Likhatcheva, Maria  ; Meric-Bernstam, Funda 
Purpose::Mutations in the ATM gene are common in multiple cancers, but clinical studies of therapies targeting ATM-aberrant cancers have yielded mixed results. Refinement of ATM loss of function (LOF) as a predictive biomarker of response is urgently needed.
 Experimental Design::We present the first disclosure and preclinical development of a novel, selective ATR inhibitor, ART0380, and test its antitumor activity in multiple preclinical cancer models. To refine ATM LOF as a predictive biomarker, we performed a comprehensive pan-cancer analysis of ATM variants in patient tumors and then assessed the ATM variant-to-protein relationship. Finally, we assessed a novel ATM LOF biomarker approach in retrospective clinical data sets of patients treated with platinum-based chemotherapy or ATR inhibition.
 Results::ART0380 had potent, selective antitumor activity in a range of preclinical cancer models with differing degrees of ATM LOF. Pan-cancer analysis identified 10,609 ATM variants in 8,587 patient tumors. Cancer lineage–specific differences were seen in the prevalence of deleterious (Tier 1) versus unknown/benign (Tier 2) variants, selective pressure for loss of heterozygosity, and concordance between a deleterious variant and ATM loss of protein (LOP). A novel ATM LOF biomarker approach that accounts for variant classification, relationship to ATM LOP, and tissue-specific penetrance significantly enriched for patients who benefited from platinum-based chemotherapy or ATR inhibition.
 Conclusions::These data help to better define ATM LOF across tumor types in order to optimize patient selection and improve molecularly targeted therapeutic approaches for patients with ATM LOF cancers.