Epidermal Growth Factor Receptor Inhibitors In Lung Cancer Research Articles

EGFL7 drives the evolution of resistance to EGFR inhibitors in lung cancer by activating NOTCH signaling

Accumulating evidence supports evolutionary trait of drug resistance. Like resilience in other systems, most tumor cells experience drug-tolerant state before full resistance acquired. However, the underlying mechanism is still poorly understood. Here, we identify that EGF like domain multiple 7 (EGFL7) is a responsive gene to epidermal growth factor receptor (EGFR) kinase inhibition during a period when tumors are decimated. Moreover, our data reveal that the adaptive increase of EGFL7 during this process is controlled by the depression of nonsense-mediated mRNA decay (NMD) pathway. Upregulation of EGFL7 activates NOTCH signaling in lung cancer cells, which slows down the decrease of c-Myc caused by EGFR inhibition, thereby helping the survival of cancer cells. Our data, taken together, demonstrate that EGFL7 is a driver gene for resistance to EGFR kinase inhibition, and suggest that targeting EGFL7/NOTCH signaling may improve the clinical benefits of EGFR inhibitors in patients with EGFR mutant tumors.

Genome-scale CRISPR screening identifies cell cycle and protein ubiquitination processes as druggable targets for erlotinib-resistant lung cancer.

Erlotinib is highly effective in lung cancer patients with epidermal growth factor receptor (EGFR) mutations. However, despite initial favorable responses, most patients rapidly develop resistance to erlotinib soon after the initial treatment. This study aims to identify new genes and pathways associated with erlotinib resistance mechanisms in order to develop novel therapeutic strategies. Here, we induced knockout (KO) mutations in erlotinib-resistant human lung cancer cells (NCI-H820) using a genome-scale CRISPR-Cas9 sgRNA library to screen for genes involved in erlotinib susceptibility. The spectrum of sgRNAs incorporated among erlotinib-treated cells was substantially different to that of the untreated cells. Gene set analyses showed a significant depletion of 'cell cycle process' and 'protein ubiquitination pathway' genes among erlotinib-treated cells. Chemical inhibitors targeting genes in these two pathways, such as nutlin-3 and carfilzomib, increased cancer cell death when combined with erlotinib in both invitro cell line and invivo patient-derived xenograft experiments. Therefore, we propose that targeting cell cycle processes or protein ubiquitination pathways are promising treatment strategies for overcoming resistance to EGFR inhibitors in lung cancer.

Herceptin: A First Assault on Oncogenes that Launched a Revolution

This year's Lasker Clinical Research Award honors H. Michael Shepard, Dennis J. Slamon, and Axel Ullrich for their invention of Herceptin, the first monoclonal antibody that blocks a cancer-causing protein, and for its development as a life-saving therapy for women with breast cancer.

Newer-Generation EGFR Inhibitors in Lung Cancer: How Are They Best Used?

The FLAURA trial established osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), as a viable first-line therapy in non-small cell lung cancer (NSCLC) with sensitizing EGFR mutations, namely exon 19 deletion and L858R. In this phase 3 randomized, controlled, double-blind trial of treatment-naïve patients with EGFR mutant NSCLC, osimertinib was compared to standard-of-care EGFR TKIs (i.e., erlotinib or gefinitib) in the first-line setting. Osimertinib demonstrated improvement in median progression-free survival (18.9 months vs. 10.2 months; hazard ratio 0.46; 95% CI, 0.37 to 0.57; p < 0.001) and a more favorable toxicity profile due to its lower affinity for wild-type EGFR. Furthermore, similar to later-generation anaplastic lymphoma kinase (ALK) inhibitors, osimertinib has improved efficacy against brain metastases. Despite this impressive effect, the optimal sequencing of osimertinib, whether in the first line or as subsequent therapy after the failure of earlier-generation EGFR TKIs, is not clear. Because up-front use of later-generation TKIs may result in the inability to use earlier-generation TKIs, this treatment paradigm must be evaluated carefully. For EGFR mutant NSCLC, considerations include the incidence of T790M resistance mutations, quality of life, whether there is a potential role for earlier-generation TKIs after osimertinib failure, and overall survival. This review explores these issues for EGFR inhibitors and other molecularly targeted therapies.

Reversal for acquired resistance to EGFR inhibitors in lung cancer

Epidermal growth factor receptor (EGFR) inhibitors targeted therapy is the forward position means for non-small cell lung cancer.However,acquired resistance to EGFR inhibitors limits the development of targeted drugs.Using existing data on drug resistance in EGFR-mutant lung cancer,this review discusses three basic approaches for overcoming resistance to EGFR-targeted therapies:intensification of EGFR inhibition,combination of EGFR inhibitors with other targeted therapies,and altering clinical management via alternate pathways. Key words: Lung neoplasms; Receptor, epidermal growth factor; Drug resistance; Inhibitors

EGFR Inhibitors Enhanced the Susceptibility to NK Cell-mediated Lysis of Lung Cancer Cells

As quercetin, which can inhibit phosphatidylinositol 3-kinase, nuclear factor-kappa B, and protein kinase C (PKC) pathways, induced expression of natural killer group 2, member D (NKG2D) ligands on cancer cells and made the cells sensitive to NK -cell-mediated killing; inhibition of epidermal growth factor receptor (EGFR) pathway might lead to induction of NKG2D ligands. In this study, it was investigated whether EGFR inhibitors, including erlotinib or gefitinib, could regulate expression of NKG2D ligands in various lung cancer cells including A549, NCI-H23, and SW-900. The EGFR inhibitors predominantly increased transcription and surface expression of ULBP1, and subsequently increased susceptibility of the cancer cells to NK-92 cells. When the selective inhibitors of nuclear factor-kappa B, phosphatidylinositol 3-kinase, mitogen-activated protein kinases, and PKC were treated to discriminate downstream signaling of EGFR pathway, expression of ULBP1 in the cancer cells was induced by inhibition of PKC. Treatment with phorbol 12-myristate 13-acetate restored the EGFR inhibitor-induced ULBP1 transcription. Binding activity to ULBP1 promoter region of AP-2α, which suggested as suppressor of expression of ULBP1, was decreased by treatment with EGFR inhibitors, and restored by pretreatment with phorbol 12-myristate 13-acetate in A549 and SW-900. Rottlerin, a PKCδ inhibitor, also decreased the binding activity of AP-2α in dose-dependent manner. This study suggests that EGFR inhibitors enhanced the susceptibility to NK cell-mediated lysis of lung cancer cells by induction of ULBP1 by inhibition of PKC pathway and therapeutic efficacy of EGFR inhibitors in lung cancer may be mediated in part by increased susceptibility to NK cell-mediated cytotoxicity.