Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, PR China.
Pharmacol Res. 2023 Feb;188:106668. doi: 10.1016/j.phrs.2023.106668. Epub 2023 Jan 18.
Favorable clinical evidence suggests that the next trend in new treatments for advanced non-small cell lung cancer (NSCLC) will be combination therapies. However, inevitable epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance greatly limits the clinical efficacy of patients carrying EGFR-activating mutants. In this study, we found a patient with clinical osimertinib resistance who regained a positive response after osimertinib plus anlotinib treatment. Two osimertinib-resistant cell lines were constructed, and AXL conferred resistance to osimertinib in NSCLC cell lines. The combined effects of anlotinib and osimertinib restored sensitivity to osimertinib in two osimertinib-resistant NSCLC cell lines and in xenografts. Moreover, anlotinib inhibits the phosphorylation of AXL in both resistant cell lines. Mechanistically, we confirmed that MYC binds to the promoter of AXL to promote its transcription in NSCLC cells, and we demonstrated that anlotinib combined with osimertinib treatment enhances the anti-tumor effect by inactivating the c-MET/MYC/AXL axis to reverse osimertinib resistance in NSCLC. In conclusion, our results provide strong support that this combination therapy may be effective in enhancing the efficacy of treatments in patients with advanced NSCLC.
有利的临床证据表明,针对晚期非小细胞肺癌(NSCLC)的新治疗方法的下一个趋势将是联合疗法。然而,不可避免的表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)耐药性极大地限制了携带 EGFR 激活突变的患者的临床疗效。在这项研究中,我们发现了一名临床奥希替尼耐药患者,在奥希替尼加安罗替尼治疗后恢复了阳性反应。构建了两种奥希替尼耐药细胞系,AXL 赋予 NSCLC 细胞系对奥希替尼的耐药性。安罗替尼和奥希替尼的联合作用恢复了两种奥希替尼耐药的 NSCLC 细胞系和异种移植物对奥希替尼的敏感性。此外,安罗替尼抑制两种耐药细胞系中 AXL 的磷酸化。在机制上,我们证实 MYC 结合到 AXL 的启动子上,促进 NSCLC 细胞中 AXL 的转录,我们证明安罗替尼联合奥希替尼治疗通过灭活 c-MET/MYC/AXL 轴增强抗肿瘤作用,从而逆转 NSCLC 中的奥希替尼耐药。总之,我们的结果提供了强有力的支持,表明这种联合治疗可能有效增强晚期 NSCLC 患者治疗的疗效。
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