Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Department of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Cancer Res. 2021 Feb 1;81(3):747-762. doi: 10.1158/0008-5472.CAN-20-1992. Epub 2020 Nov 17.
Malignant peripheral nerve sheath tumors often arise in patients with neurofibromatosis type 1 and are among the most treatment-refractory types of sarcoma. Overall survival in patients with relapsed disease remains poor, and thus novel therapeutic approaches are needed. NF1 is essential for negative regulation of RAS activity and is altered in about 90% of malignant peripheral nerve sheath tumors (MPNST). A complex interplay of upstream signaling and parallel RAS-driven pathways characterizes NF1-driven tumorigenesis, and inhibiting more than one RAS effector pathway is therefore necessary. To devise potential combination therapeutic strategies, we identified actionable alterations in signaling that underlie adaptive and acquired resistance to MEK inhibitor (MEKi). Using a series of proteomic, biochemical, and genetic approaches in an model of MEKi resistance provided a rationale for combination therapies. HGF/MET signaling was elevated in the MEKi-resistant model. HGF overexpression conferred resistance to MEKi in parental cells. Depletion of HGF or MET restored sensitivity of MEKi-resistant cells to MEKi. Finally, a combination of MEK and MET inhibition demonstrated activity in models of MPNST and may therefore be effective in patients with MPNST harboring genetic alterations in . SIGNIFICANCE: This study demonstrates that MEKi plus MET inhibitor may delay or prevent a novel mechanism of acquired MEKi resistance, with clinical implications for MPNST patients harboring alterations.
恶性外周神经鞘瘤常发生于神经纤维瘤病 1 型患者中,是最难治疗的肉瘤类型之一。复发性疾病患者的总体生存率仍然较差,因此需要新的治疗方法。NF1 是 RAS 活性负调控所必需的,约 90%的恶性外周神经鞘瘤(MPNST)发生改变。上游信号和并行 RAS 驱动途径的复杂相互作用特征是 NF1 驱动的肿瘤发生,因此需要抑制多个 RAS 效应途径。为了设计潜在的联合治疗策略,我们确定了信号通路中的可操作改变,这些改变是对 MEK 抑制剂(MEKi)的适应性和获得性耐药的基础。在 MEKi 耐药模型中,一系列蛋白质组学、生化和遗传方法的应用为联合治疗提供了依据。在 MEKi 耐药模型中,HGF/MET 信号被上调。HGF 过表达赋予亲本细胞对 MEKi 的耐药性。HGF 或 MET 的耗竭恢复了 MEKi 耐药细胞对 MEKi 的敏感性。最后,MEK 和 MET 抑制的联合应用在 MPNST 模型中显示出活性,因此可能对携带 改变的 MPNST 患者有效。
意义:这项研究表明,MEKi 加 MET 抑制剂可能延迟或预防 MEKi 获得性耐药的新机制,对携带 改变的 MPNST 患者具有临床意义。
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