Dual targeting of EGFR can overcome a major drug resistance mutation in mouse models of EGFR mutant lung cancer

TLDR

EGFR is a key anticancer target in epithelial tumors, and tyrosine kinase inhibitors such as gefitinib and erlotinib elicit strong responses in EGFR‑mutant lung adenocarcinomas, yet resistance inevitably develops due to additional TKI‑resistant EGFR mutations. This study used transgenic mouse lung tumor models to test strategies for overcoming the most common resistance mutation, T790M. Mice bearing EGFR‑mutant tumors were treated with a new irreversible EGFR TKI (BIBW‑2992) and the EGFR‑specific antibody cetuximab. The combination of BIBW‑2992 and cetuximab produced dramatic tumor shrinkage in erlotinib‑resistant, T790M‑positive tumors by depleting both phosphorylated and total EGFR, indicating that dual targeting could counteract T790M‑mediated resistance and serve as a model for other RTK‑driven cancers.

Abstract

EGFR is a major anticancer drug target in human epithelial tumors. One effective class of agents is the tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib. These drugs induce dramatic responses in individuals with lung adenocarcinomas characterized by mutations in exons encoding the EGFR tyrosine kinase domain, but disease progression invariably occurs. A major reason for such acquired resistance is the outgrowth of tumor cells with additional TKI-resistant EGFR mutations. Here we used relevant transgenic mouse lung tumor models to evaluate strategies to overcome the most common EGFR TKI resistance mutation, T790M. We treated mice bearing tumors harboring EGFR mutations with a variety of anticancer agents, including a new irreversible EGFR TKI that is under development (BIBW-2992) and the EGFR-specific antibody cetuximab. Surprisingly, we found that only the combination of both agents together induced dramatic shrinkage of erlotinib-resistant tumors harboring the T790M mutation, because together they efficiently depleted both phosphorylated and total EGFR. We suggest that these studies have immediate therapeutic implications for lung cancer patients, as dual targeting with cetuximab and a second-generation EGFR TKI may be an effective strategy to overcome T790M-mediated drug resistance. Moreover, this approach could serve as an important model for targeting other receptor tyrosine kinases activated in human cancers.