XPO1-dependent nuclear export is a druggable vulnerability in KRAS-mutant lung cancer

Nature. 2016 Oct 6;538(7623):114-117. doi: 10.1038/nature19771. Epub 2016 Sep 28.

Abstract

The common participation of oncogenic KRAS proteins in many of the most lethal human cancers, together with the ease of detecting somatic KRAS mutant alleles in patient samples, has spurred persistent and intensive efforts to develop drugs that inhibit KRAS activity. However, advances have been hindered by the pervasive inter- and intra-lineage diversity in the targetable mechanisms that underlie KRAS-driven cancers, limited pharmacological accessibility of many candidate synthetic-lethal interactions and the swift emergence of unanticipated resistance mechanisms to otherwise effective targeted therapies. Here we demonstrate the acute and specific cell-autonomous addiction of KRAS-mutant non-small-cell lung cancer cells to receptor-dependent nuclear export. A multi-genomic, data-driven approach, utilizing 106 human non-small-cell lung cancer cell lines, was used to interrogate 4,725 biological processes with 39,760 short interfering RNA pools for those selectively required for the survival of KRAS-mutant cells that harbour a broad spectrum of phenotypic variation. Nuclear transport machinery was the sole process-level discriminator of statistical significance. Chemical perturbation of the nuclear export receptor XPO1 (also known as CRM1), with a clinically available drug, revealed a robust synthetic-lethal interaction with native or engineered oncogenic KRAS both in vitro and in vivo. The primary mechanism underpinning XPO1 inhibitor sensitivity was intolerance to the accumulation of nuclear IκBα (also known as NFKBIA), with consequent inhibition of NFκB transcription factor activity. Intrinsic resistance associated with concurrent FSTL5 mutations was detected and determined to be a consequence of YAP1 activation via a previously unappreciated FSTL5-Hippo pathway regulatory axis. This occurs in approximately 17% of KRAS-mutant lung cancers, and can be overcome with the co-administration of a YAP1-TEAD inhibitor. These findings indicate that clinically available XPO1 inhibitors are a promising therapeutic strategy for a considerable cohort of patients with lung cancer when coupled to genomics-guided patient selection and observation.

MeSH terms

  • Active Transport, Cell Nucleus / drug effects*
  • Adaptor Proteins, Signal Transducing / antagonists & inhibitors
  • Adaptor Proteins, Signal Transducing / metabolism
  • Animals
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / metabolism
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Cell Line, Tumor
  • Cell Nucleus / drug effects
  • Cell Nucleus / metabolism*
  • Cell Proliferation / drug effects
  • Cell Survival / drug effects
  • Cell Survival / genetics
  • DNA-Binding Proteins / antagonists & inhibitors
  • DNA-Binding Proteins / metabolism
  • Exportin 1 Protein
  • Female
  • Follistatin-Related Proteins / genetics
  • Genes, Lethal / genetics
  • Hippo Signaling Pathway
  • Humans
  • Karyopherins / antagonists & inhibitors*
  • Karyopherins / metabolism*
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / genetics*
  • Lung Neoplasms / metabolism*
  • Lung Neoplasms / pathology
  • Mice
  • Mutation
  • NF-KappaB Inhibitor alpha / metabolism
  • NF-kappa B / antagonists & inhibitors
  • NF-kappa B / metabolism
  • Nuclear Proteins / antagonists & inhibitors
  • Nuclear Proteins / metabolism
  • Phosphoproteins / antagonists & inhibitors
  • Phosphoproteins / metabolism
  • Porphyrins / pharmacology
  • Protein Serine-Threonine Kinases / metabolism
  • Proto-Oncogene Proteins p21(ras) / genetics*
  • RNA Interference
  • RNA, Small Interfering
  • Receptors, Cytoplasmic and Nuclear / antagonists & inhibitors*
  • Receptors, Cytoplasmic and Nuclear / metabolism*
  • Signal Transduction
  • TEA Domain Transcription Factors
  • Transcription Factors / antagonists & inhibitors
  • Transcription Factors / metabolism
  • Verteporfin
  • Xenograft Model Antitumor Assays
  • YAP-Signaling Proteins

Substances

  • Adaptor Proteins, Signal Transducing
  • DNA-Binding Proteins
  • FSTL5 protein, human
  • Follistatin-Related Proteins
  • KRAS protein, human
  • Karyopherins
  • NF-kappa B
  • Nuclear Proteins
  • Phosphoproteins
  • Porphyrins
  • RNA, Small Interfering
  • Receptors, Cytoplasmic and Nuclear
  • TEA Domain Transcription Factors
  • TEAD1 protein, human
  • Transcription Factors
  • YAP-Signaling Proteins
  • YAP1 protein, human
  • Verteporfin
  • NF-KappaB Inhibitor alpha
  • Protein Serine-Threonine Kinases
  • Proto-Oncogene Proteins p21(ras)