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旁系敏感网络揭示了 ALK 突变型非小细胞肺癌中的进化不稳定性和新的治疗策略。

Collateral sensitivity networks reveal evolutionary instability and novel treatment strategies in ALK mutated non-small cell lung cancer.

机构信息

Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA.

Department of Oncology, University of Oxford, Oxford, UK.

出版信息

Sci Rep. 2017 Apr 27;7(1):1232. doi: 10.1038/s41598-017-00791-8.

Abstract

Drug resistance remains an elusive problem in cancer therapy, particularly for novel targeted therapies. Much work is focused upon the development of an arsenal of targeted therapies, towards oncogenic driver genes such as ALK-EML4, to overcome the inevitable resistance that develops over time. Currently, after failure of first line ALK TKI therapy, another ALK TKI is administered, though collateral sensitivity is not considered. To address this, we evolved resistance in an ALK rearranged non-small cell lung cancer line (H3122) to a panel of 4 ALK TKIs, and performed a collateral sensitivity analysis. All ALK inhibitor resistant cell lines displayed significant cross-resistance to all other ALK inhibitors. We then evaluated ALK-inhibitor sensitivities after drug holidays of varying length (1-21 days), and observed dynamic patterns of resistance. This unpredictability led us to an expanded search for treatment options, where we tested 6 further anti-cancer agents for collateral sensitivity among resistant cells, uncovering possibilities for further treatment, including cross-sensitivity to standard cytotoxic therapies, as well as Hsp90 inhibitors. Taken together, these results imply that resistance to targeted therapy in non-small cell lung cancer is highly dynamic, and also one where there are many opportunities to re-establish sensitivities where there was once resistance. Drug resistance in cancer inevitably emerges during treatment; particularly with novel targeted therapies, designed to inhibit specific molecules. A clinically-relevant example of this phenomenon occurs in ALK-positive non-small cell lung cancer, where targeted therapies are used to inhibit the ALK-EML4 fusion protein. A potential solution to this may lie in finding drug sensitivities in the resistant population, termed collateral sensitivities, and then using these as second-line agents. This study shows how the evolution of resistance in ALK-positive lung cancer is a dynamic process through time, one in which patterns of drug resistance and collateral sensitivity change substantially, and therefore one where temporal regimens, such as drug cycling and drug holidays may have great benefit.

摘要

耐药性仍然是癌症治疗中的一个难以解决的问题,特别是对于新型靶向治疗。目前,大量工作集中在开发针对致癌驱动基因(如 ALK-EML4)的靶向治疗武器库,以克服随着时间的推移不可避免产生的耐药性。目前,在一线 ALK TKI 治疗失败后,会使用另一种 ALK TKI,但不考虑旁系敏感性。为了解决这个问题,我们使 ALK 重排的非小细胞肺癌细胞系(H3122)对一组 4 种 ALK TKI 产生耐药性,并进行了旁系敏感性分析。所有 ALK 抑制剂耐药细胞系对所有其他 ALK 抑制剂均显示出显著的交叉耐药性。然后,我们评估了不同时长(1-21 天)药物停药后的 ALK 抑制剂敏感性,并观察了耐药性的动态变化。这种不可预测性促使我们扩大了治疗方案的搜索范围,在耐药细胞中测试了另外 6 种抗癌药物的旁系敏感性,发现了进一步治疗的可能性,包括对标准细胞毒性疗法的交叉敏感性,以及 HSP90 抑制剂。总之,这些结果表明,非小细胞肺癌中靶向治疗的耐药性是高度动态的,而且在曾经耐药的情况下,有很多机会重新建立敏感性。癌症的耐药性在治疗过程中不可避免地会出现;特别是对于新型靶向治疗,旨在抑制特定分子。ALK 阳性非小细胞肺癌中就存在这种现象的临床相关例子,其中靶向治疗用于抑制 ALK-EML4 融合蛋白。一种潜在的解决方案可能在于在耐药人群中寻找药物敏感性,称为旁系敏感性,然后将其作为二线药物使用。这项研究表明,ALK 阳性肺癌中耐药性的演变是一个随时间变化的动态过程,在这个过程中,耐药性和旁系敏感性的模式会发生很大变化,因此,时间性治疗方案,如药物循环和药物停药,可能会带来很大的益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f422/5430816/d7df81bcb2c1/41598_2017_791_Fig1_HTML.jpg

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