Placing purines in precision medicine: Targeting a metabolic reliance in KRAS-mutant tumors.

TitlePlacing purines in precision medicine: Targeting a metabolic reliance in KRAS-mutant tumors.
Publication TypeJournal Article
Year of Publication2026
AuthorsDe Boni L, Claridge S, Nath S, Tofani K, Stein BD, Park E, Steiner S, Elemento O, Pauli C, Hopkins BD
JournaliScience
Volume29
Issue3
Pagination114954
Date Published2026 Mar 20
ISSN2589-0042
Abstract

Precision oncology workflows rely heavily on genomic identification of oncogenic driver mutations or the functional loss of tumor suppressors. These pipelines can identify single-agent treatments for patients, but monotherapy is often insufficient and can drive resistance. Recently, functional drug screening has been employed to evaluate tumor-specific drug sensitivities that complement molecular testing. We describe a resistance evaluation after first line exposure (REFLEX) multi-omic paradigm using drug-induced molecular changes to prioritize effective hits from combination screening. In KRAS-mutant cancer models, trametinib treatment caused dysregulation of the purine biosynthetic pathway driven by reductions in enzyme GART. This induced vulnerability nominated purine analog 6-thioguanine as a synergistic partner. Across diverse KRAS-mutant lineages, trametinib-induced GART loss predicts sensitivity to the combination. In vivo, the treatment significantly increases overall survival without systemic toxicity. Integrating drug-induced multi-omic changes with functional screening identifies therapeutic strategies, supporting the use of purine analogs with MEK inhibitors for KRAS-mutant tumors.

DOI10.1016/j.isci.2026.114954
Alternate JournaliScience
PubMed ID41767257
PubMed Central IDPMC12937152