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Figarol S, Delahaye C, Gence R, Doussine A, Cerapio JP, Brachais M, Tardy C, Béry N, Asslan R, Colinge J, Villemin JP, Maraver A, Ferrer I, Paz-Ares L, Kessler L, Burrows F, Lajoie-Mazenc I, Dongay V, Morin C, Florent A, Pagano S, Taranchon-Clermont E, Casanova A, Pradines A, Mazieres J, Favre G, Calvayrac O. Farnesyltransferase inhibition overcomes oncogene-addicted non-small cell lung cancer adaptive resistance to targeted therapies. Nat Commun 2024; 15:5345. [PMID: 38937474 PMCID: PMC11211478 DOI: 10.1038/s41467-024-49360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024] Open
Abstract
Drug-tolerance has emerged as one of the major non-genetic adaptive processes driving resistance to targeted therapy (TT) in non-small cell lung cancer (NSCLC). However, the kinetics and sequence of molecular events governing this adaptive response remain poorly understood. Here, we combine real-time monitoring of the cell-cycle dynamics and single-cell RNA sequencing in a broad panel of oncogenic addiction such as EGFR-, ALK-, BRAF- and KRAS-mutant NSCLC, treated with their corresponding TT. We identify a common path of drug adaptation, which invariably involves alveolar type 1 (AT1) differentiation and Rho-associated protein kinase (ROCK)-mediated cytoskeletal remodeling. We also isolate and characterize a rare population of early escapers, which represent the earliest resistance-initiating cells that emerge in the first hours of treatment from the AT1-like population. A phenotypic drug screen identify farnesyltransferase inhibitors (FTI) such as tipifarnib as the most effective drugs in preventing relapse to TT in vitro and in vivo in several models of oncogenic addiction, which is confirmed by genetic depletion of the farnesyltransferase. These findings pave the way for the development of treatments combining TT and FTI to effectively prevent tumor relapse in oncogene-addicted NSCLC patients.
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Affiliation(s)
- Sarah Figarol
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Célia Delahaye
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Rémi Gence
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Aurélia Doussine
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Juan Pablo Cerapio
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Mathylda Brachais
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Claudine Tardy
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nicolas Béry
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Raghda Asslan
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Jacques Colinge
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Jean-Philippe Villemin
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Antonio Maraver
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Irene Ferrer
- Unidad de Investigación Clínica de Cáncer de Pulmón, Instituto de Investigación Hospital 12 de Octubre-CNIO, Madrid, Spain
| | - Luis Paz-Ares
- Unidad de Investigación Clínica de Cáncer de Pulmón, Instituto de Investigación Hospital 12 de Octubre-CNIO, Madrid, Spain
| | | | | | - Isabelle Lajoie-Mazenc
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Vincent Dongay
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire (CHU) de Toulouse, service de pneumologie, Toulouse, France
| | - Clara Morin
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire (CHU) de Toulouse, service de pneumologie, Toulouse, France
| | - Amélie Florent
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sandra Pagano
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Estelle Taranchon-Clermont
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
- Oncopole Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire de Biologie Médicale Oncologique, Toulouse, France
| | - Anne Casanova
- Oncopole Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire de Biologie Médicale Oncologique, Toulouse, France
| | - Anne Pradines
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
- Oncopole Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire de Biologie Médicale Oncologique, Toulouse, France
| | - Julien Mazieres
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire (CHU) de Toulouse, service de pneumologie, Toulouse, France
| | - Gilles Favre
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France.
- Oncopole Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Laboratoire de Biologie Médicale Oncologique, Toulouse, France.
| | - Olivier Calvayrac
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm, CNRS, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France.
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Zhu Y, Dai Z. HSP90: A promising target for NSCLC treatments. Eur J Pharmacol 2024; 967:176387. [PMID: 38311278 DOI: 10.1016/j.ejphar.2024.176387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
The emergence of targeted therapies and immunotherapies has improved the overall survival of patients with nonsmall cell lung cancer (NSCLC), but the 5-year survival rate remains low. New drugs are needed to overcome this dilemma. Moreover, the significant correlation between various client proteins of heat-shock protein (HSP) 90 and tumor occurrence, progression, and drug resistance suggests that HSP90 is a potential therapeutic target for NSCLC. However, the outcomes of clinical trials for HSP90 inhibitors have been disappointing, indicating significant toxicity of these drugs and that further screening of the beneficiary population is required. NSCLC patients with oncogenic-driven gene mutations or those at advanced stages who are resistant to multi-line treatments may benefit from HSP90 inhibitors. Enhancing the therapeutic efficacy and reducing the toxicity of HSP90 inhibitors can be achieved via the optimization of their drug structure, using them in combination therapies with low-dose HSP90 inhibitors and other drugs, and via targeted administration to tumor lesions. Here, we provide a review of the recent research on the role of HSP90 in NSCLC and summarize relevant studies of HSP90 inhibitors in NSCLC.
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Affiliation(s)
- Yue Zhu
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, Liaoning Province, China
| | - Zhaoxia Dai
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, Liaoning Province, China.
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Gadgeel SM, Miao J, Riess JW, Moon J, Mack PC, Gerstner GJ, Burns TF, Taj A, Akerley WL, Dragnev KH, Laudi N, Redman MW, Gray JE, Gandara DR, Kelly K. Phase II Study of Docetaxel and Trametinib in Patients with KRAS Mutation Positive Recurrent Non-Small Cell Lung Cancer (NSCLC; SWOG S1507, NCT-02642042). Clin Cancer Res 2023; 29:3641-3649. [PMID: 37233987 PMCID: PMC10526968 DOI: 10.1158/1078-0432.ccr-22-3947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/24/2023] [Accepted: 05/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Efficacy of MEK inhibitors in KRAS+ NSCLC may differ based on specific KRAS mutations and comutations. Our hypothesis was that docetaxel and trametinib would improve activity in KRAS+ NSCLC and specifically in KRAS G12C NSCLC. PATIENTS AND METHODS S1507 is a single-arm phase II study assessing the response rate (RR) with docetaxel plus trametinib in recurrent KRAS+ NSCLC and secondarily in the G12C subset. The accrual goal was 45 eligible patients, with at least 25 with G12C mutation. The design was two-stage design to rule out a 17% RR, within the overall population at the one-sided 3% level and within the G12C subset at the 5% level. RESULTS Between July 18, 2016, and March 15, 2018, 60 patients were enrolled with 53 eligible and 18 eligible in the G12C cohort. The RR was 34% [95% confidence interval (CI), 22-48] overall and 28% (95% CI, 10-53) in G12C. Median PFS and OS were 4.1 and 3.3 months and 10.9 and 8.8 months, overall and in the subset, respectively. Common toxicities were fatigue, diarrhea, nausea, rash, anemia, mucositis, and neutropenia. Among 26 patients with known status for TP53 (10+ve) and STK11 (5+ve), OS (HR, 2.85; 95% CI, 1.16-7.01), and RR (0% vs. 56%, P = 0.004) were worse in patients with TP53 mutated versus wild-type cancers. CONCLUSIONS RRs were significantly improved in the overall population. Contrary to preclinical studies, the combination showed no improvement in efficacy in G12C patients. Comutations may influence therapeutic efficacy of KRAS directed therapies and are worthy of further evaluation. See related commentary by Cantor and Aggarwal, p. 3563.
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Affiliation(s)
| | - Jieling Miao
- SWOG Statistical and Data Management Center
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | - James Moon
- SWOG Statistical and Data Management Center
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | | | - Asma Taj
- Michigan CRC NCORP/St. Mary’s of Michigan, Saginaw, MI
| | | | | | - Noel Laudi
- Mercy Hospital/Minnesota Community Oncology Research Consortium, Coon Rapids, MN
| | - Mary W. Redman
- SWOG Statistical and Data Management Center
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Karen Kelly
- University of California, Davis, Sacramento, CA
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Lietman CD, Johnson ML, McCormick F, Lindsay CR. More to the RAS Story: KRAS G12C Inhibition, Resistance Mechanisms, and Moving Beyond KRAS G12C. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35561303 DOI: 10.1200/edbk_351333] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the discovery of RAS oncogenes in human tumor DNA 40 years ago, the development of effective targeted therapies directed against RAS has lagged behind those more successful advancements in the field of therapeutic tyrosine kinase inhibitors targeting other oncogenes such as EGFR, ALK, and ROS1. The discoveries that (1) malignant RAS oncogenes differ from their wild-type counterparts by only a single amino acid change and (2) covalent inhibition of the cysteine residue at codon 12 of KRASG12C in its inactive GDP-bound state resulted in effective inhibition of oncogenic RAS signaling and have catalyzed a dramatic shift in mindset toward KRAS-driven cancers. Although the development of allele-selective KRASG12C inhibitors has changed a treatment paradigm, the clinical activity of these agents is more modest than tyrosine kinase inhibitors targeting other oncogene-driven cancers. Heterogeneous resistance mechanisms generally result in the restoration of RAS/mitogen-activated protein kinase pathway signaling. Many approaches are being evaluated to overcome this resistance, with many combinatorial clinical trials ongoing. Furthermore, because KRASG12D and KRASG12V are more prevalent than KRASG12C, there remains an unmet need for additional therapeutic strategies for these patients. Thus, our current translational standing could be described as "the end of the beginning," with additional discovery and research innovation needed to address the enormous disease burden imposed by RAS-mutant cancers. Here, we describe the development of KRASG12C inhibitors, the challenges of resistance to these inhibitors, strategies to mitigate that resistance, and new approaches being taken to address other RAS-mutant cancers.
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Affiliation(s)
| | | | - Frank McCormick
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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