TOPII-targeting and MUS81 deficiency sensitise HER2-low tumour models to T-DXd

In this study, we identify Topoisomerase II α (TopII α) targeting and MUS81 deficiency as sensitisers to trastuzumab deruxtecan (T-DXd), a HER2-targeting antibody–drug conjugate with a potent topoisomerase I poison payload that is of clinical importance in the treatment of HER2 expressing solid tumours in a range of cancer types. Using preclinical tumour spheroid models of breast and colorectal cancer, we show that TopII α targeting with doxorubicin sensitises HER2-low tumour cells to T-DXd, elevating cell cytotoxicity, DNA damage, and checkpoint pathway activation. T-DXd treatment, both as a single agent and in combination with doxorubicin, increases TopII α expression, highlighting this nuclear endonuclease as a potential candidate biomarker for T-DXd response in both the HER2-high and HER2-low setting. Using isogenic CRISPR models, we show that genetic loss of the MUS81 structure-specific endonuclease, a key processor of branched DNA structures and under-replicated DNA, sensitises HER2-low colorectal cancer cells to T-DXd. Given that reduced expression of MUS81 is closely related to metastasis and poor prognosis in colorectal carcinoma, our findings highlight the potential utility of these treatment combinations in a subset of colorectal cancer patients that present with HER2-positve/MUS81-low disease.