Han Song, Tushoski-Alemán Gerik W, Zhang Peiyi, Zheng Guangrong, Zhou Daohong, Huo Zhiguang, Licht Jonathan, George Thomas J, Allegra Carmen, Trevino Jose G, Hughes Steven J
Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA.
Neoplasia. 2025 Jan;59:101070. doi: 10.1016/j.neo.2024.101070. Epub 2024 Nov 14.
Oncogenic KRAS signaling plays a critical role in pancreatic ductal adenocarcinoma (PDAC) biology. Recent studies indicate that the combination of MEK and BCL-xL inhibition is synthetically lethal and holds promise for some types of solid cancers, however, patient response was poorly observed in PDAC predominantly due to amplified EGFR signaling. Here, we leverage the advantage of the combinational treatment strategy and designed a triplet regimen targeting the comprehensive RAS activation networks through simultaneously blocking MEK/BCL-xL/EGFR. The cytotoxicity of trametinib (MEK inhibitor), DT2216 (BCL-xL degrader) and afatinib (pan-EGFR inhibitor) and their combination was tested in patient-derived, primary PDAC cells using a live cell imaging system. Patient-derived xenograft (PDX) model was employed for the evaluation of the therapeutic efficacy and safety of the combinational regimen. Targeted pathway cascades activities were analyzed using multiplex phosphor-immune assays. In vitro comparisons showed the addition of afatinib as a third agent was statistically superior compared to a doublet of trametinib+DT2216 in suppressing cell growth and inducing cell death in all cell lines tested. This triplet similarly demonstrated significant superiority over the doublet of MEK/BCL-xL inhibition in the in vivo murine model. The triplet regimen was well tolerated in vivo. Overall tumor growth rates were significantly reduced in doublet treatment compared to controls, and further reduced in the triplet treatment group. Pathway analysis revealed the addition of afatinib in triplet regimen further inhibited PI3K/AKT effectors of p90RSK, p70S6K, and GSK3α/β along with a secondary pathway of P38 MAPK. Our study identifies an important contribution of EGFR inhibition to elevate the response of PDAC, supporting a clinical assessment of this triplet combination in patients.
致癌性KRAS信号通路在胰腺导管腺癌(PDAC)生物学中起着关键作用。最近的研究表明,MEK和BCL-xL抑制的联合具有合成致死性,对某些类型的实体癌具有前景,然而,在PDAC中患者反应不佳,主要是由于EGFR信号通路的扩增。在此,我们利用联合治疗策略的优势,设计了一种三联疗法,通过同时阻断MEK/BCL-xL/EGFR来靶向全面的RAS激活网络。使用活细胞成像系统,在患者来源的原发性PDAC细胞中测试了曲美替尼(MEK抑制剂)、DT2216(BCL-xL降解剂)和阿法替尼(泛EGFR抑制剂)及其组合的细胞毒性。采用患者来源的异种移植(PDX)模型评估联合疗法的治疗效果和安全性。使用多重磷酸免疫测定法分析靶向信号通路级联活性。体外比较显示,在所有测试的细胞系中,添加阿法替尼作为第三种药物在抑制细胞生长和诱导细胞死亡方面在统计学上优于曲美替尼+DT2216的双联组合。在体内小鼠模型中,这种三联疗法同样显示出比MEK/BCL-xL抑制的双联组合具有显著优势。三联疗法在体内耐受性良好。与对照组相比,双联治疗组的总体肿瘤生长率显著降低,而三联治疗组进一步降低。通路分析显示,三联疗法中添加阿法替尼进一步抑制了p90RSK、p70S6K和GSK3α/β的PI3K/AKT效应器以及P38 MAPK的二级通路。我们的研究确定了EGFR抑制对提高PDAC反应的重要作用,支持对该三联组合在患者中的临床评估。
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