A combinatorial strategy for treating KRAS-mutant lung cancer

Eusebio Manchado, Susann Weissmueller, John P. Morris, Chi-Chao Chen, Ramona Wullenkord, Amaia Lujambio, Elisa de Stanchina, John T. Poirier, Justin F. Gainor, Ryan B. Corcoran, Jeffrey A. Engelman, Charles M. Rudin, Neal Rosen () and Scott W. Lowe ()
Additional contact information
Eusebio Manchado: Memorial Sloan Kettering Cancer Center
Susann Weissmueller: Memorial Sloan Kettering Cancer Center
John P. Morris: Memorial Sloan Kettering Cancer Center
Chi-Chao Chen: Memorial Sloan Kettering Cancer Center
Ramona Wullenkord: Memorial Sloan Kettering Cancer Center
Amaia Lujambio: Memorial Sloan Kettering Cancer Center
Elisa de Stanchina: Memorial Sloan Kettering Cancer Center
John T. Poirier: Memorial Sloan Kettering Cancer Center
Justin F. Gainor: Massachusetts General Hospital Cancer Center
Ryan B. Corcoran: Massachusetts General Hospital Cancer Center
Jeffrey A. Engelman: Massachusetts General Hospital Cancer Center
Charles M. Rudin: Memorial Sloan Kettering Cancer Center
Neal Rosen: Memorial Sloan Kettering Cancer Center
Scott W. Lowe: Memorial Sloan Kettering Cancer Center

Nature, 2016, vol. 534, issue 7609, 647-651

Abstract: Abstract Therapeutic targeting of KRAS-mutant lung adenocarcinoma represents a major goal of clinical oncology. KRAS itself has proved difficult to inhibit, and the effectiveness of agents that target key KRAS effectors has been thwarted by activation of compensatory or parallel pathways that limit their efficacy as single agents. Here we take a systematic approach towards identifying combination targets for trametinib, a MEK inhibitor approved by the US Food and Drug Administration, which acts downstream of KRAS to suppress signalling through the mitogen-activated protein kinase (MAPK) cascade. Informed by a short-hairpin RNA screen, we show that trametinib provokes a compensatory response involving the fibroblast growth factor receptor 1 (FGFR1) that leads to signalling rebound and adaptive drug resistance. As a consequence, genetic or pharmacological inhibition of FGFR1 in combination with trametinib enhances tumour cell death in vitro and in vivo. This compensatory response shows distinct specificities: it is dominated by FGFR1 in KRAS-mutant lung and pancreatic cancer cells, but is not activated or involves other mechanisms in KRAS wild-type lung and KRAS-mutant colon cancer cells. Importantly, KRAS-mutant lung cancer cells and patients’ tumours treated with trametinib show an increase in FRS2 phosphorylation, a biomarker of FGFR activation; this increase is abolished by FGFR1 inhibition and correlates with sensitivity to trametinib and FGFR inhibitor combinations. These results demonstrate that FGFR1 can mediate adaptive resistance to trametinib and validate a combinatorial approach for treating KRAS-mutant lung cancer.

Date: 2016
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DOI: 10.1038/nature18600

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