Exploiting the Therapeutic Interaction of WNT Pathway Activation and Asparaginase for Colorectal Cancer Therapy.

Colorectal cancer (CRC) is driven by mutations that activate canonical WNT/B-catenin signaling, but inhibiting WNT has significant on-target toxicity, and there are no approved therapies targeting dominant oncogenic drivers. We recently found that activating a B-catenin independent branch of WNT signaling that inhibits GSK3-dependent protein degradation induces asparaginase sensitivity in drug-resistant leukemias. To test predictions from our model, we turned to CRC because these can have WNT-activating mutations that function either upstream (i.e., R-spondin fusions) or downstream (APC or B-catenin mutations) of GSK3, thus allowing WNT/B-catenin and WNT-induced asparaginase sensitivity to be unlinked genetically. We found that asparaginase had little efficacy in APC or B-catenin mutant CRC, but was profoundly toxic in the setting of R-spondin fusions. Pharmacologic GSK3A inhibition was sufficient for asparaginase sensitization in APC or B-catenin mutant CRC, but not in normal intestinal progenitors. Our findings demonstrate that WNT-induced therapeutic vulnerabilities can be exploited for CRC therapy.