Consensus molecular subtype 4 (CMS4)-targeted therapy in primary colon cancer: a proof-of-concept study
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Background: Mesenchymal Consensus Molecular Subtype 4 (CMS4) colon cancer is associated with poor prognosis and therapy resistance. In this proof-of-concept study, we assessed whether a rationally chosen drug could mitigate the distinguishing molecular features of primary CMS4 colon cancer. Methods: In the ImPACCT trial, informed consent was obtained for molecular subtyping at initial diagnosis of colon cancer using a validated RT-qPCR CMS4-test on three biopsies per tumor (Phase-1, n=69 patients), and for neoadjuvant CMS4-targeting therapy with imatinib (Phase-2, n=5). Pre- and post-treatment tumor biopsies were analyzed by RNA-sequencing and immunohistochemistry. Imatinib-induced gene expression changes were associated with molecular subtypes and survival in an independent cohort of 3232 primary colon cancer. Results: The CMS4-test classified 52/172 biopsies as CMS4 (30%). Five patients consented to imatinib treatment prior to surgery, yielding 15 pre- and 15 post-treatment samples for molecular analysis. Imatinib treatment caused significant suppression of mesenchymal genes and upregulation of genes encoding epithelial junctions. The gene expression changes induced by imatinib were associated with improved survival and a shift from CMS4 to CMS2. Conclusion: Imatinib may have value as a CMS-switching drug in primary colon cancer and induces a gene expression program that is associated with improved survival.
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Imatinib suppresses mesenchymal genes in posttreatment samples from 5 patients with primary CMS4 colorectal cancer who consented to treatment prior to surgery.
“| PDGF pathway | Imatinib | Suppression of mesenchymal genes in posttreatment samples (n = 5 patients with primary CMS4 colorectal cancer who consented to treatment prior to surgery) | (63) |”
From Clinical Challenges of Consensus Molecular Subtype CMS4 Colon Cancer in the Era of Precision Medicine (2024) · cites this paper as [63]
Positive responses have been reported for CMS4 patients treated with imatinib before surgery, in a very limited number of patients.
“positive responses have been reported for CMS4 patients treated with (i) imatinib—targeting the PDGF pathway—before surgery (ImPACCT trial), however in a very limited number of patients (63)”
From Clinical Challenges of Consensus Molecular Subtype CMS4 Colon Cancer in the Era of Precision Medicine (2024) · cites this paper as [63]
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Self-citation
- Authors
- Peters, N. A., Constantinides, A., Ubink, I., van Kuik, J., Bloemendal, H. J., van Dodewaard, J. M., Brink, M. A., Schwartz, T. P., Lolkema, M. P. J. K., Lacle, M. M., Moons, L. M., Geesing, J., van Grevenstein, W. M. U., Roodhart, J. M. L., Koopman, M., Elias, S. G., Borel Rinkes, I. H. M., & Kranenburg, O.
- Affiliations
- Utrecht University (NL)
- Radboud University Medical Center (NL)
- Meander Medisch Centrum (NL)
- Erasmus MC (NL)
- Diakonessenhuis hospital (NL)
- Corresponding author
- Kranenburg, Onno
- ORCID
- Venue
- Frontiers in Oncology
- Publisher
- Frontiers Media SA
- Published
- 2022-09-06
- Volume
- 12
- Pages
- 969855-969855
- ISSN
- 2234-943X (ISSN-L)
- PMC
- PMC9486194
- OpenAlex
- W4294739303
- Cited by
- 35
- References
- 54
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 8 · 2023: 9 · 2022: 1
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Oncology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- ZonMw (95104001)
- KWF Kankerbestrijding (2014-6617)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Keywords
- colon cancer, imatinib, neoadjuvant therapy, mesenchymal subtype, epithelial-mesenchymal transition, gene expression changes, survival, molecular subtyping
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