Center for Advanced Preclinical Research, SAIC-Frederick, Inc, Frederick National Laboratory for Cancer Research/NCI, Frederick, Maryland 21702, USA.
Cancer Res. 2012 Nov 15;72(22):5921-33. doi: 10.1158/0008-5472.CAN-12-0736. Epub 2012 Sep 11.
Patients with lung cancer with activating mutations in the EGF receptor (EGFR) kinase, who are treated long-term with tyrosine kinase inhibitors (TKI), often develop secondary mutations in EGFR associated with resistance. Mice engineered to develop lung adenocarcinomas driven by the human EGFR T790M resistance mutation are similarly resistant to the EGFR TKI erlotinib. By tumor volume endpoint analysis, these mouse tumors respond to BIBW 2992 (an irreversible EGFR/HER2 TKI) and rapamycin combination therapy. To correlate EGFR-driven changes in the lung with response to drug treatment, we conducted an integrative analysis of global transcriptome and metabolite profiling compared with quantitative imaging and histopathology at several time points during tumor progression and treatment. Responses to single-drug treatments were temporary, whereas combination therapy elicited a sustained response. During tumor development, metabolomic signatures indicated a shift to high anabolic activity and suppression of antitumor programs with 11 metabolites consistently present in both lung tissue and blood. Combination drug treatment reversed many of the molecular changes found in tumored lung. Data integration linking cancer signaling networks with metabolic activity identified key pathways such as glutamine and glutathione metabolism that signified response to single or dual treatments. Results from combination drug treatment suggest that metabolic transcriptional control through C-MYC and SREBP, as well as ELK1, NRF1, and NRF2, depends on both EGFR and mTORC1 signaling. Our findings establish the importance of kinetic therapeutic studies in preclinical assessment and provide in vivo evidence that TKI-mediated antiproliferative effects also manifest in specific metabolic regulation.
具有表皮生长因子受体(EGFR)激酶激活突变的肺癌患者,长期接受酪氨酸激酶抑制剂(TKI)治疗,常发生与耐药相关的 EGFR 继发性突变。构建的携带人类 EGFR T790M 耐药突变的肺腺癌小鼠对 EGFR TKI 厄洛替尼同样具有耐药性。通过肿瘤体积终点分析,这些小鼠肿瘤对 BIBW 2992(一种不可逆的 EGFR/HER2 TKI)和雷帕霉素联合治疗有反应。为了将肺内 EGFR 驱动的变化与药物治疗反应相关联,我们在肿瘤进展和治疗的几个时间点进行了全球转录组和代谢组学综合分析,并与定量成像和组织病理学进行了比较。单一药物治疗的反应是暂时的,而联合治疗则引起持续的反应。在肿瘤发展过程中,代谢组学特征表明代谢活性升高,抗肿瘤程序受到抑制,有 11 种代谢物在肺组织和血液中均持续存在。联合药物治疗逆转了肿瘤肺中发现的许多分子变化。将癌症信号网络与代谢活性相关联的数据整合确定了关键途径,如谷氨酰胺和谷胱甘肽代谢,这些途径标志着对单一或双重治疗的反应。联合药物治疗的结果表明,通过 C-MYC 和 SREBP 以及 ELK1、NRF1 和 NRF2 进行代谢转录控制,取决于 EGFR 和 mTORC1 信号。我们的研究结果确立了在临床前评估中进行动力学治疗研究的重要性,并提供了体内证据,表明 TKI 介导的抗增殖作用也表现在特定的代谢调节中。