Vertical suppression of the EGFR pathway prevents onset of resistance in colorectal cancers

Nat Commun. 2015 Sep 22:6:8305. doi: 10.1038/ncomms9305.

Abstract

Molecular targeted drugs are clinically effective anti-cancer therapies. However, tumours treated with single agents usually develop resistance. Here we use colorectal cancer (CRC) as a model to study how the acquisition of resistance to EGFR-targeted therapies can be restrained. Pathway-oriented genetic screens reveal that CRC cells escape from EGFR blockade by downstream activation of RAS-MEK signalling. Following treatment of CRC cells with anti-EGFR, anti-MEK or the combination of the two drugs, we find that EGFR blockade alone triggers acquired resistance in weeks, while combinatorial treatment does not induce resistance. In patient-derived xenografts, EGFR-MEK combination prevents the development of resistance. We employ mathematical modelling to provide a quantitative understanding of the dynamics of response and resistance to these single and combination therapies. Mechanistically, we find that the EGFR-MEK Combo blockade triggers Bcl-2 and Mcl-1 downregulation and initiates apoptosis. These results provide the rationale for clinical trials aimed at preventing rather than intercepting resistance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Agents / pharmacology*
  • Cell Line
  • Cetuximab / administration & dosage
  • Cetuximab / therapeutic use
  • Colorectal Neoplasms / metabolism*
  • Drug Resistance, Neoplasm*
  • ErbB Receptors / metabolism*
  • Humans
  • Intracellular Signaling Peptides and Proteins
  • Mice
  • Mitogen-Activated Protein Kinase Kinases / metabolism
  • Neoplasms, Experimental
  • Panitumumab
  • Transplantation, Heterologous

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • FILIP1L protein, human
  • Intracellular Signaling Peptides and Proteins
  • Panitumumab
  • ErbB Receptors
  • Mitogen-Activated Protein Kinase Kinases
  • Cetuximab