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非小细胞肺癌中 EGFR 通路激活介导的对 ROS1 抑制的耐药性。

Resistance to ROS1 inhibition mediated by EGFR pathway activation in non-small cell lung cancer.

机构信息

Department of Medicine, Division of Medical Oncology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America.

Department of Pathology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States of America.

出版信息

PLoS One. 2013 Dec 13;8(12):e82236. doi: 10.1371/journal.pone.0082236. eCollection 2013.

Abstract

The targeting of oncogenic 'driver' kinases with small molecule inhibitors has proven to be a highly effective therapeutic strategy in selected non-small cell lung cancer (NSCLC) patients. However, acquired resistance to targeted therapies invariably arises and is a major limitation to patient care. ROS1 fusion proteins are a recently described class of oncogenic driver, and NSCLC patients that express these fusions generally respond well to ROS1-targeted therapy. In this study, we sought to determine mechanisms of acquired resistance to ROS1 inhibition. To accomplish this, we analyzed tumor samples from a patient who initially responded to the ROS1 inhibitor crizotinib but eventually developed acquired resistance. In addition, we generated a ROS1 inhibition-resistant derivative of the initially sensitive NSCLC cell line HCC78. Previously described mechanisms of acquired resistance to tyrosine kinase inhibitors including target kinase-domain mutation, target copy number gain, epithelial-mesenchymal transition, and conversion to small cell lung cancer histology were found to not underlie resistance in the patient sample or resistant cell line. However, we did observe a switch in the control of growth and survival signaling pathways from ROS1 to EGFR in the resistant cell line. As a result of this switch, ROS1 inhibition-resistant HCC78 cells became sensitive to EGFR inhibition, an effect that was enhanced by co-treatment with a ROS1 inhibitor. Our results suggest that co-inhibition of ROS1 and EGFR may be an effective strategy to combat resistance to targeted therapy in some ROS1 fusion-positive NSCLC patients.

摘要

针对致癌“驱动”激酶的小分子抑制剂的靶向治疗已被证明是一种非常有效的治疗策略,在某些非小细胞肺癌(NSCLC)患者中。然而,获得性耐药性不可避免地出现,是患者护理的主要限制。ROS1 融合蛋白是最近描述的一类致癌驱动基因,表达这些融合基因的 NSCLC 患者通常对 ROS1 靶向治疗反应良好。在这项研究中,我们试图确定获得性 ROS1 抑制耐药的机制。为此,我们分析了一名最初对 ROS1 抑制剂克唑替尼有反应但最终出现获得性耐药的患者的肿瘤样本。此外,我们生成了最初敏感的 NSCLC 细胞系 HCC78 的 ROS1 抑制耐药衍生系。先前描述的酪氨酸激酶抑制剂获得性耐药机制,包括靶激酶结构域突变、靶基因拷贝数增加、上皮-间充质转化和转化为小细胞肺癌组织学,在患者样本或耐药细胞系中均未发现与耐药性相关。然而,我们确实观察到在耐药细胞系中,控制生长和存活信号通路的开关从 ROS1 切换到了 EGFR。由于这种切换,ROS1 抑制耐药的 HCC78 细胞对 EGFR 抑制变得敏感,ROS1 抑制剂的联合治疗增强了这种敏感性。我们的结果表明,ROS1 和 EGFR 的联合抑制可能是对抗某些 ROS1 融合阳性 NSCLC 患者对靶向治疗耐药的有效策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c94d/3862576/2c4bcf10df9c/pone.0082236.g001.jpg

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