克服致癌基因融合单药治疗的耐药性:MAPK和PI3K/mTOR信号通路的联合靶向治疗
Overcoming resistance to single-agent therapy for oncogenic gene fusions combinatorial targeting of MAPK and PI3K/mTOR signaling pathways.
作者信息
Jain Payal, Silva Amanda, Han Harry J, Lang Shih-Shan, Zhu Yuankun, Boucher Katie, Smith Tiffany E, Vakil Aesha, Diviney Patrick, Choudhari Namrata, Raman Pichai, Busch Christine M, Delaney Tim, Yang Xiaodong, Olow Aleksandra K, Mueller Sabine, Haas-Kogan Daphne, Fox Elizabeth, Storm Phillip B, Resnick Adam C, Waanders Angela J
机构信息
Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
出版信息
Oncotarget. 2017 Sep 15;8(49):84697-84713. doi: 10.18632/oncotarget.20949. eCollection 2017 Oct 17.
Pediatric low-grade gliomas (PLGGs) are frequently associated with activating gene fusions, such as KIAA1549-BRAF, that aberrantly drive the mitogen activated protein kinase (MAPK) pathway. Although RAF inhibitors (RAFi) have been proven effective in BRAF-V600E mutant tumors, we have previously shown how the KIAA1549-BRAF fusion can be paradoxically activated by RAFi. While newer classes of RAFi, such as PLX8394, have now been shown to inhibit MAPK activation by KIAA1549-BRAF, we sought to identify alternative MAPK pathway targeting strategies using clinically relevant MEK inhibitors (MEKi), along with potential escape mechanisms of acquired resistance to single-agent MAPK pathway therapies. We demonstrate effectiveness of multiple MEKi against diverse BRAF-fusions with novel N-terminal partners, with trametinib being the most potent. However, resistance to MEKi or PLX8394 develops increased RTK expression causing activation of PI3K/mTOR pathway in BRAF-fusion expressing resistant clones. To circumvent acquired resistance, we show potency of combinatorial targeting with trametinib and everolimus, an mTOR inhibitor (mTORi) against multiple BRAF-fusions. While single-agent mTORi and MEKi PLGG clinical trials are underway, our study provides preclinical rationales for using MEKi and mTORi combinatorial therapy to stave off or prevent emergent drug-resistance in BRAF-fusion driven PLGGs.
小儿低度恶性胶质瘤(PLGGs)常与激活基因融合相关,如KIAA1549 - BRAF,其异常驱动丝裂原活化蛋白激酶(MAPK)通路。尽管RAF抑制剂(RAFi)已被证实在BRAF - V600E突变肿瘤中有效,但我们之前已表明KIAA1549 - BRAF融合如何能被RAFi反常激活。虽然现在已证明新型RAFi,如PLX8394,可抑制KIAA1549 - BRAF介导的MAPK激活,但我们试图确定使用临床相关的MEK抑制剂(MEKi)靶向MAPK通路的替代策略,以及对单药MAPK通路疗法获得性耐药的潜在逃逸机制。我们证明了多种MEKi对具有新型N端伴侣的不同BRAF融合蛋白有效,曲美替尼最为有效。然而,对MEKi或PLX8394的耐药会导致RTK表达增加,从而在表达BRAF融合蛋白的耐药克隆中激活PI3K/mTOR通路。为了规避获得性耐药,我们展示了曲美替尼与mTOR抑制剂(mTORi)依维莫司联合靶向多种BRAF融合蛋白的效力。虽然单药mTORi和MEKi在PLGG临床试验中正在进行,但我们的研究为使用MEKi和mTORi联合疗法来延缓或预防BRAF融合驱动的PLGG中出现的耐药提供了临床前理论依据。