Learning and actioning general principles of cancer cell drug sensitivity

High-throughput screening platforms for the profiling of drug sensitivity of hundreds of cancer cell lines (CCLs) have generated large datasets that hold the potential to unlock targeted, anti-tumor therapies. In this study, we leveraged these datasets to create predictive models of cancer cells drug sensitivity. To this aim we trained explainable machine learning algorithms by employing cell line transcriptomics to predict the growth inhibitory potential of drugs. We used large language models (LLMs) to expand descriptions of the mechanisms of action (MOA) for each drug starting from available annotations, which were matched to the semantically closest pathways from reference knowledge bases. By leveraging this AI-curated resource, and the interpretability of our model, we demonstrated that pathways enriched for genes crucial for prediction often matched known drug-MOAs and essential genes, suggesting that our models learned the molecular determinants of drug response. Furthermore, we demonstrated that by incorporating only LLM-curated genes associated with MOAs, we enhanced the predictive accuracy of our drug models. To enhance translatability to a clinical setting, we employed a pipeline to align bulk RNAseq from CCLs, used for training the models, to those from patient samples, used for inference. We proved the effectiveness of our approach on TCGA samples, where patients best scoring drugs matched those prescribed for their cancer type. We further showed its usefulness by predicting and experimentally validating effective drugs for the patients of two highly lethal solid tumors, i.e. pancreatic cancer and glioblastoma. In summary, our method facilitates the inference and interpretation of cancer cell line drug sensitivity and holds potential to effectively translate them into new cancer therapeutics. Highlights-Interpretable drug-response prediction models were trained on large scale pharmacogenomics data sets (i.e. GDSC and PRISM). -Large language models were used to enhance the curation of biological pathways associated to drugs MOA -Unbiased interpretation of the models demonstrated learning of drug MOAs and gene essentiality -Inference of TCGA cohort samples recovered mono- and combination cancer drug prescriptions and indicate potential repurposing candidates. -Drug candidates predicted from bulk RNAseq samples of pancreatic cancer and glioblastoma were experimentally validated.