Patient-Derived Nasopharyngeal Cancer Organoids for Disease Modeling and Radiation Dose Optimization

Sasidharan Swarnalatha Lucky; Martin Law; Ming Hong Lui; Jamie Mong; Junli Shi; Sidney Yu; Do Kun Yoon; Shih Kien Djeng; Jiguang Wang; Chwee Ming Lim; Min Han Tan

doi:10.3389/fonc.2021.622244

Patient-Derived Nasopharyngeal Cancer Organoids for Disease Modeling and Radiation Dose Optimization

Front Oncol. 2021 Feb 23:11:622244. doi: 10.3389/fonc.2021.622244. eCollection 2021.

Authors

Affiliations

¹ Institute of Bioengineering and Nanotechnology, Agency for Science Technology and Research (ASTAR), Singapore, Singapore.
² Proton Therapy Centre Pte Ltd., Singapore, Singapore.
³ Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong.
⁴ Division of Life Science, Department of Chemical and Biological Engineering, Center for Systems Biology and Human Health and State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore.
⁶ Department of Otolaryngology, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract

Effective radiation treatment (RT) for recurrent nasopharyngeal cancers (NPC), featuring an intrinsic hypoxic sub-volume, remains a clinical challenge. Lack of disease-specific in-vitro models of NPC, together with difficulties in establishing patient derived xenograft (PDX) models, have further hindered development of personalized therapeutic options. Herein, we established two NPC organoid lines from recurrent NPC PDX models and further characterized and compared these models with original patient tumors using RNA sequencing analysis. Organoids were cultured in hypoxic conditions to examine the effects of hypoxia and radioresistance. These models were then utilized to determine the radiobiological parameters, such as α/β ratio and oxygen enhancement ratio (OER), characteristic to radiosensitive normoxic and radioresistant hypoxic NPC, using simple dose-survival data analytic tools. The results were further validated in-vitro and in-vivo, to determine the optimal boost dose and fractionation regimen required to achieve effective NPC tumor regression. Despite the differences in tumor microenvironment due to the lack of human stroma, RNA sequencing analysis revealed good correlation of NPC PDX and organoid models with patient tumors. Additionally, the established models also mimicked inter-tumoral heterogeneity. Hypoxic NPC organoids were highly radioresistant and had high α/β ratio compared to its normoxic counterparts. In-vitro and in-vivo fractionation studies showed that hypoxic NPC was less sensitive to RT fractionation scheme and required a large bolus dose or 1.4 times of the fractionated dose that was effective against normoxic cells in order to compensate for oxygen deficiency. This study is the first direct experimental evidence to predict optimal RT boost dose required to cause sufficient damage to recurrent hypoxic NPC tumor cells, which can be further used to develop dose-painting algorithms in clinical practice.

Keywords: hypoxia; linear quadratic model; organoids model; oxygen enhancement ratio; patient-derived xenografts; radioresistance; radiotherapy; recurrent NPC.