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Gulay KCM, Zhang X, Pantazopoulou V, Patel J, Esparza E, Pran Babu DS, Ogawa S, Weitz J, Ng I, Mose ES, Pu M, Engle DD, Lowy AM, Tiriac H. Dual Inhibition of KRASG12D and Pan-ERBB Is Synergistic in Pancreatic Ductal Adenocarcinoma. Cancer Res 2023; 83:3001-3012. [PMID: 37378556 PMCID: PMC10502451 DOI: 10.1158/0008-5472.can-23-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer with a low survival rate. Recently, new drugs that target KRASG12D, a common mutation in PDAC, have been developed. We studied one of these compounds, MRTX1133, and found it was specific and effective at low nanomolar concentrations in patient-derived organoid models and cell lines harboring KRASG12D mutations. Treatment with MRTX1133 upregulated the expression and phosphorylation of EGFR and HER2, indicating that inhibition of ERBB signaling may potentiate MRTX1133 antitumor activity. Indeed, the irreversible pan-ERBB inhibitor, afatinib, potently synergized with MRTX1133 in vitro, and cancer cells with acquired resistance to MRTX1133 in vitro remained sensitive to this combination therapy. Finally, the combination of MRTX1133 and afatinib led to tumor regression and longer survival in orthotopic PDAC mouse models. These results suggest that dual inhibition of ERBB and KRAS signaling may be synergistic and circumvent the rapid development of acquired resistance in patients with KRAS mutant pancreatic cancer. SIGNIFICANCE KRAS-mutant pancreatic cancer models, including KRAS inhibitor-resistant models, show exquisite sensitivity to combined pan-ERBB and KRAS targeting, which provides the rationale for testing this drug combination in clinical trials.
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Affiliation(s)
- Kevin Christian Montecillo Gulay
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Xinlian Zhang
- Department of Family Medicine and Public Health, Division of Biostatistics and Bioinformatics, University of California San Diego, San Diego, California
| | - Vasiliki Pantazopoulou
- Salk Institute for Biological Studies, San Diego, California
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Jay Patel
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Edgar Esparza
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Deepa Sheik Pran Babu
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Satoshi Ogawa
- Salk Institute for Biological Studies, San Diego, California
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jonathan Weitz
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Isabella Ng
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Evangeline S. Mose
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Minya Pu
- Department of Family Medicine and Public Health, Division of Biostatistics and Bioinformatics, University of California San Diego, San Diego, California
| | | | - Andrew M. Lowy
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
| | - Hervé Tiriac
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California San Diego, San Diego, California
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