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Mutations in oncogenes such as KRAS and EGFR cause a high proportion of lung cancers. Drugs targeting these proteins cause tumor regression but ultimately fail to elicit cures. As a result, there is an intense interest in how to best combine targeted therapies with other treatments, such as immunotherapies. However, preclinical systems for studying the interaction of lung tumors with the host immune system are inadequate, in part due to the low tumor mutational burden in genetically engineered mouse models. Here we set out to develop mouse models of mutant KRAS–driven lung cancer with an elevated tumor mutational burden by expressing the human DNA cytosine deaminase, APOBEC3B, to mimic the mutational signature seen in human lung cancer. This failed to substantially increase clonal tumor mutational burden and autochthonous tumors remained refractory to immunotherapy. However, establishing clonal cell lines from these tumors enabled the generation of an immunogenic syngeneic transplantation model of KRAS-mutant lung adenocarcinoma that was sensitive to immunotherapy. Unexpectedly, antitumor immune responses were not directed against neoantigens but instead targeted derepressed endogenous retroviral antigens. The ability of KRASG12C inhibitors to cause regression of KRASG12C -expressing tumors was markedly potentiated by the adaptive immune system, highlighting the importance of using immunocompetent models for evaluating targeted therapies. Overall, this model provides a unique opportunity for the study of combinations of targeted and immunotherapies in immune-hot lung cancer.Significance:This study develops a mouse model of immunogenic KRAS-mutant lung cancer to facilitate the investigation of optimal combinations of targeted therapies with immunotherapies.

Supplementary Data from An Immunogenic Model of KRAS-Mutant Lung Cancer Enables Evaluation of Targeted Therapy and Immunotherapy Combinations

Supplementary Table from An Immunogenic Model of KRAS-Mutant Lung Cancer Enables Evaluation of Targeted Therapy and Immunotherapy Combinations

Oncogenic BRAF is a critical driver of proliferation and survival and is thus a validated therapeutic target in cancer. We have developed a potent inhibitor, termed 1t (CCT239065), of the mutant protein kinase, V600EBRAF. 1t inhibits signaling downstream of V600EBRAF in cancer cells, blocking DNA synthesis, and inhibiting proliferation. Importantly, we show that 1t is considerably more selective for mutated BRAF cancer cell lines compared with wild-type BRAF lines. The inhibitor is well tolerated in mice and exhibits excellent oral bioavailability (F = 71%). Suppression of V600EBRAF-mediated signaling in human tumor xenografts was observed following oral administration of a single dose of 1t. As expected, the growth rate in vivo of a wild-type BRAF human tumor xenograft model is unaffected by inhibitor 1t. In contrast, 1t elicits significant therapeutic responses in mutant BRAF–driven human melanoma xenografts. Cancer Res; 70(20); 8036–44. ©2010 AACR.

Supplementary Figure 1 from A Novel, Selective, and Efficacious Nanomolar Pyridopyrazinone Inhibitor of V600EBRAF

Supplementary Table 1 from A Novel, Selective, and Efficacious Nanomolar Pyridopyrazinone Inhibitor of V600EBRAF

Supplementary Table 2 from A Novel, Selective, and Efficacious Nanomolar Pyridopyrazinone Inhibitor of V600EBRAF

Recently developed KRAS G12C inhibitory drugs are beneficial to lung cancer patients harboring KRAS G12C mutations, but drug resistance frequently develops. Because of the immunosuppressive nature of the signaling network controlled by oncogenic KRAS, these drugs can indirectly affect antitumor immunity, providing a rationale for their combination with immune checkpoint blockade. In this study, we have characterized how KRAS G12C inhibition reverses immunosuppression driven by oncogenic KRAS in a number of preclinical lung cancer models with varying levels of immunogenicity. Mechanistically, KRAS G12C inhibition up-regulates interferon signaling via Myc inhibition, leading to reduced tumor infiltration by immunosuppressive cells, enhanced infiltration and activation of cytotoxic T cells, and increased antigen presentation. However, the combination of KRAS G12C inhibitors with immune checkpoint blockade only provides synergistic benefit in the most immunogenic tumor model. KRAS G12C inhibition fails to sensitize cold tumors to immunotherapy, with implications for the design of clinical trials combining KRAS G12C inhibitors with anti-PD1 drugs.

Recently developed KRAS

The recent approval of KRASG12C mutant-specific inhibitors has transformed the clinical practice of lung cancer patients harboring KRASG12C mutations. However, clinical data show that resistance develops rapidly after initial responses, suggesting that combination therapies will be needed. Ideally, these combinations should not only overcome adaptive or acquired resistance but also maintain or even enhance the positive immunomodulatory effects that KRASG12C inhibitors (G12Ci) have in the tumor microenvironment (TME). Most of the G12Ci being tested in clinical trials target GDP-bound KRAS (OFF state), which makes them vulnerable to upstream pathway reactivation. In this study we use a covalent tri-complex KRASG12C(ON) inhibitor, RM-029, which targets KRASG12C in the active state. Treatment with RM-029 still resulted in some degree of adaptive RAS pathway reactivation, which can be blocked using the SHP2 inhibitor RMC-4550. In vivo, this combination enhanced tumor regressions and improved overall survival in two different KRASG12C lung cancer models. In an immunogenic KRASG12C lung cancer model both KRASG12C(ON) and SHP2 inhibitors remodel the TME and are able to drive durable responses, which are enhanced when both compounds are combined. However, in this anti-PD1 sensitive model the combination of RM-029 with anti-PD1 generated more complete responses than the combination of RM-029 and RMC-4550. In an immune-excluded anti-PD1 resistant model, KRASG12C(ON) and SHP2 inhibitors also promoted a profound remodelling of the TME, with increased infiltration and activation of T cells accompanied by a reduction of tumor-promoting myeloid cells. Importantly, only the combination of both KRASG12C(ON) and SHP2 inhibitors sensitized these immune-excluded tumors to anti-PD1 blockade, resulting in durable responses and immune memory. Our preclinical results show that RM-029 as single agent or in combination with RMC-4550 and/or anti-PD1 can induce anti-tumor immunity and generate complete responses, especially in immunogenic models. To study if this immunological response could also target G12Ci-resistant subpopulations within the tumor, we used our immunogenic cell line (KPAR) to generate reporter-traced G12Ci sensitive (KPARG12C) and resistant (KPARG12D) cells that can be monitored over time via in vivo luciferase imaging and end point flow cytometry. We find evidence of bystander immune mediated killing of G12Ci-resistant cells in response to the different treatment combinations. Overall, our preclinical results demonstrate the potential of the combination of KRASG12C(ON) inhibitors with SHP2 and/or immune checkpoint blockade not only by targeting KRAS-driven proliferation in tumor cells but by stimulating anti-tumor immunity to target both G12Ci sensitive and resistant cells. Citation Format: Panayiotis Anastasiou, Mona Tomaschko, Jesse Boumelha, Sareena Rana, Christopher Moore, Miriam Molina-Arcas, Julian Downward. Combining KRASG12C(ON) inhibition with SHP2 and immune checkpoint blockade to enhance anti-tumor immunity and overcome development of resistance in lung cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5733.

The recent development and approval of KRASG12C inhibitors promises to change profoundly the clinical management of lung cancer patients harbouring KRASG12C mutations. However, early clinical data indicate that acquired drug resistance can frequently develop after the initial response. Due to the immunosuppressive nature of the signaling network controlled by oncogenic KRAS, targeted KRASG12C inhibition can indirectly affect anti-tumour immunity. This has served as a rationale for combination with immune checkpoint blockade, showing therapeutic benefit in certain immunogenic pre-clinical tumour models. In this study, we characterised how KRASG12C inhibition reverses immune suppression driven by oncogenic KRAS in a number of pre-clinical lung cancer models with varying levels of immunogenicity. Mechanistically, KRASG12C inhibition upregulates interferon pathway gene expression via inhibition of Myc and, in tumours, leads to reduced infiltration of immunosuppressive cells, increased interferon responses and antigen presentation, and also enhanced infiltration and activation of cytotoxic T cells. However, the combination of KRASG12C inhibitors with immune checkpoint blockade only provides synergistic benefit in the most immunogenic tumour model, with KRASG12C inhibition failing to sensitize cold tumours to immunotherapy. In immunogenic tumours, complete responses to KRASG12C inhibition requires tumour cell autonomous interferon γ signaling. Our data have important implications for the design of clinical trials combining KRASG12C inhibitors with anti-PD-1 drugs and suggest that additional combination strategies will be needed for immunotherapy refractory patients. One sentence summary KRASG12C inhibition mobilizes anti-tumour immunity in immunogenic lung cancer models through derepressing interferon signaling via repression of Myc.

Mouse models are critical in pre-clinical studies of cancer therapy, allowing dissection of mechanisms through chemical and genetic manipulations that are not feasible in the clinical setting. In studies of the tumour microenvironment (TME), novel highly multiplexed imaging methods can provide a rich source of information. However, the application of such technologies in mouse tissues is still in its infancy. Here we present a workflow for studying the TME using imaging mass cytometry with a panel of 27 antibodies on frozen mouse tissues. We optimised and validated image segmentation strategies and automated the process in a Nextflow-based pipeline (imcyto) that is scalable and portable, allowing for parallelised segmentation of large multi-image datasets. Incorporating user-specific plugins, imcyto can be flexibly tailored to a wide range of segmentation needs. With these methods we interrogated the dramatic remodelling of the TME induced by a KRAS G12C inhibitor in an immune competent mouse orthotopic lung cancer model, showcasing their potential as key discovery tools to enhance understanding of the interplay between tumour, stroma, and immune cells in the spatial context of the tissue.

Oncogenic mutations in KRAS are frequent in non-small cell lung cancer and have been associated with poor prognosis. The recent development and approval of KRASG12C mutant-specific inhibitors could change the clinical practice of lung cancer patients harboring KRASG12C mutations. However, early clinical data indicate the development of acquired resistance after initial responses. All of the KRASG12C inhibitors being tested in clinical trials to date target GDP-bound KRAS (OFF state), which makes them vulnerable to upstream pathway reactivation, as this will increase KRAS in a GTP-bound (ON) state and therefore reduce drug efficacy. In this study we use a covalent tri-complex KRASG12C(ON) inhibitor which targets KRASG12C in the active state. In vitro, the KRASG12C(ON) inhibitor RM-029 exhibited higher efficacy than the KRASG12C(OFF) inhibitor MRTX849 (adagrasib). However, treatment with RM-029 also showed adaptive RAS pathway reactivation after 24 hours of treatment, which can be blocked using the SHP2 inhibitor RMC-4550, suggesting that pathway reactivation is mediated by signaling from RTKs to RAS proteins. In vivo, KRASG12C(ON) treatment led to strong regression of KRASG12C tumors and addition of a SHP2 inhibitor significantly increased anti-tumor responses. Single treatments with KRASG12C(ON) or SHP2 inhibitors led to complete responses in some animals and immunological memory in an immune responsive KRASG12C lung tumor model, with all tumors showing complete responses when the inhibitors were combined. Consistent with this finding, both KRASG12C(ON) and SHP2 inhibition resulted in a profound remodeling of the lung tumor microenvironment (TME), with increased infiltration and activation of T cells accompanied by a reduction of tumor-promoting myeloid cells. Interestingly, similar changes were obtained in an immune evasive KRASG12C lung cancer model. Besides acting upstream RAS, SHP2 has also specific roles in immune cells, including regulation of T cell function. As comparison, responses to SOS1 inhibition, which acts only upstream RAS, have also been analyzed. Overall, our preclinical results show that the anti-tumor activity of the combination of KRASG12C(ON) with SHP2 inhibition is the result of different mechanisms. First, a KRASG12C(ON) inhibitor potently inhibits oncogenic RAS and addition of a SHP2 inhibitor blocks RAS pathway reactivation increasing tumor responses. Second, both inhibitors have beneficial effects in the TME which can be potentiated when combined. Finally, addition of a SHP2 inhibitor could potentially overcome intrinsic resistant populations by directly targeting cells resistant to G12C inhibition and/or by increasing anti-tumor immunity. Citation Format: Panayiotis Anastasiou, Edurne Mugarza, Jesse Boumelha, Sareena Rana, Christopher Moore, Miriam Molina-Arcas, Julian Downward. Combination of KRASG12C(ON) and SHP2 inhibitors overcomes adaptive resistance and enhances anti-tumor immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4029.

Triple-negative breast cancer (TNBC) has poorer prognosis compared to other types of breast cancers due to the lack of effective therapies and markers for patient stratification. Loss of PTEN tumor suppressor gene expression is a frequent event in TNBC, resulting in over-activation of the PI 3-kinase (PI3K) pathway and sensitivity to its inhibition. However, PI3K pathway inhibitors show limited efficacy as monotherapies on these tumors. We report a whole-genome screen to identify targets whose inhibition enhanced the effects of different PI3K pathway inhibitors on PTEN-null TNBC. This identified a signaling network that relies on both the G protein-coupled receptor for thrombin (PAR1/F2R) and downstream G protein βγ subunits and also epidermal growth factor receptor (EGFR) for the activation of the PI3K isoform p110β and AKT. Compensation mechanisms involving these two branches of the pathway could bypass PI3K blockade, but combination targeting of both EGFR and PI3Kβ suppressed ribosomal protein S6 phosphorylation and exerted anti-tumor activity both in vitro and in vivo, suggesting a new potential therapeutic strategy for PTEN-null TNBC.

Therapeutic KRASG12C inhibitors may substantially improve KRAS-mutant cancer patient care, considering the encouraging clinical data emerging from ongoing clinical trials. Since oncogene-targeting therapies often lead to resistance, the development of combinatorial therapies will be of utmost importance to achieve long-lasting tumour control. Given the known immunosuppressive role of KRAS, clinical trials investigating the combination of KRASG12C inhibitors with immune checkpoint blockade are currently underway for NSCLC patients. Here, we show that KRASG12C inhibition using MRTX1257 alleviates KRAS-driven immune suppression, through a myriad of mechanisms including the augmentation of tumour cell-intrinsic interferon responses. Despite harbouring a large number of somatic mutations, orthotopic 3LL (KRASG12CDNRAS) tumours are able to evade anti-tumour immune responses. Combining multicolour flow cytometry, RNA sequencing and imaging mass cytometry, we observed significantly increased T cell activation and infiltration after MRTX1257 treatment in addition to enhanced antigen presentation cells and gene sets, and reduced myeloid cells, creating an immune permissive microenvironment in these lung tumours. Despite these profound changes, combination of KRASG12C inhibitors and anti-PD-(L)1 antibodies fail to show synergism in our model, in contrast with Amgen’s published data using an immunogenic model of colorectal cancer. This data suggests that a pre-existing anti-tumour immunity may be crucial for clinical responses to KRAS inhibitors and immune checkpoint blockade combinations. Henceforth, ongoing clinical trials investigating this approach will likely only benefit a subset of patients and further research will be needed to examine novel therapeutic approaches and combinations for refractory patients. Citation Format: Edurne Mugarza, Febe Van Maldegem, Jesse Boumelha, Chris Moore, Sareena Rana, Miriam Llorian Sopena, Phil East, Miriam Molina Arcas, Julian Downward. Therapeutic KRASG12C inhibition alleviates KRAS-driven immunosuppression [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P111.

KRAS represents an excellent therapeutic target in lung cancer, the most commonly mutated form of which can now be blocked using KRAS-G12C mutant-specific inhibitory trial drugs. Lung adenocarcinoma cells harboring KRAS mutations have been shown previously to be selectively sensitive to inhibition of mitogen-activated protein kinase kinase (MEK) and insulin-like growth factor 1 receptor (IGF1R) signaling. Here, we show that this effect is markedly enhanced by simultaneous inhibition of mammalian target of rapamycin (mTOR) while maintaining selectivity for the KRAS-mutant genotype. Combined mTOR, IGF1R, and MEK inhibition inhibits the principal signaling pathways required for the survival of KRAS-mutant cells and produces marked tumor regression in three different KRAS-driven lung cancer mouse models. Replacing the MEK inhibitor with the mutant-specific KRAS-G12C inhibitor ARS-1620 in these combinations is associated with greater efficacy, specificity, and tolerability. Adding mTOR and IGF1R inhibitors to ARS-1620 greatly improves its effectiveness on KRAS-G12C mutant lung cancer cells in vitro and in mouse models. This provides a rationale for the design of combination treatments to enhance the impact of the KRAS-G12C inhibitors, which are now entering clinical trials.

The BRAF kinase and the MAPK pathway are targets of current melanoma therapies. However, MAPK pathway inhibition results in dynamic changes of downstream targets that can counteract inhibitor‐action not only in during treatment, but also in acquired resistant tumours. One such dynamic change involves the expression of the transcription factor MITF, a crucial regulator of cell survival and proliferation in untreated as well as drug‐addicted acquired resistant melanoma. Tight control over MITF expression levels is required for optimal melanoma growth, and while it is well established that the MAPK pathway regulates MITF expression, the actual mechanism is insufficiently understood. We reveal here, how BRAF through action on the transcription factors BRN2 and PAX3 executes control over the regulation of MITF expression in a manner that allows for considerable plasticity. This plasticity provides robustness to the BRAF mediated MITF regulation and explains the dynamics in MITF expression that are observed in patients in response to MAPK inhibitor therapy.

We used a combination of whole-genome sequencing and in vitro validation to show that mutations that activated at least two pro-growth/survival pathways mediated intrinsic resistance to BRAF inhibition in a melanoma patient. These data demonstrate how in-depth analysis can reveal intrinsic resistance to standard of care, providing an opportunity for alternative therapeutic strategies for patients who are likely to fail first-line treat-575 ment., Background BRAF is mutated in ∼42% of human melanomas (COSMIC. http://www.sanger.ac.uk/genetics/CGP/cosmic/) and pharmacological BRAF inhibitors such as vemurafenib and dabrafenib achieve dramatic responses in patients whose tumours harbour BRAFV600 mutations. Objective responses occur in ∼50% of patients and disease stabilisation in a further ∼30%, but ∼20% of patients present primary or innate resistance and do not respond. Here, we investigated the underlying cause of treatment failure in a patient with BRAF mutant melanoma who presented primary resistance. Methods We carried out whole-genome sequencing and single nucleotide polymorphism (SNP) array analysis of five metastatic tumours from the patient. We validated mechanisms of resistance in a cell line derived from the patient's tumour. Results We observed that the majority of the single-nucleotide variants identified were shared across all tumour sites, but also saw site-specific copy-number alterations in discrete cell populations at different sites. We found that two ubiquitous mutations mediated resistance to BRAF inhibition in these tumours. A mutation in GNAQ sustained mitogen-activated protein kinase (MAPK) signalling, whereas a mutation in PTEN activated the PI3 K/AKT pathway. Inhibition of both pathways synergised to block the growth of the cells. Conclusions Our analyses show that the five metastases arose from a common progenitor and acquired additional alterations after disease dissemination. We demonstrate that a distinct combination of mutations mediated primary resistance to BRAF inhibition in this patient. These mutations were present in all five tumours and in a tumour sample taken before BRAF inhibitor treatment was administered. Inhibition of both pathways was required to block tumour cell growth, suggesting that combined targeting of these pathways could have been a valid therapeutic approach for this patient.

Oncogenic mutations in KRAS are frequent in non-small cell lung cancer (NSCLC) and have been associated with poor prognosis and resistance to existing therapies. We have previously shown that NSCLC cells harboring KRAS mutations are selectively sensitive to inhibition of MEK and IGF1R signaling. Using a whole-genome shRNA screen, we shown that this effect is markedly enhanced by simultaneous inhibition of mTOR, while maintaining selectivity for the KRAS mutant genotype. Mechanistic investigations demonstrated that IGF1R inhibitors block the reactivation of the PI3K pathway induced by mTOR inhibition, resulting in a robust suppression of PI3K and mTORC1 signalling. Addition of a MEK inhibitor to the combination results in simultaneous inhibition of the main nodes downstream of RAS. Notably, the inhibition of these signalling pathways is stronger in KRAS-mutant cells than in their wild-type counterparts. Combining MEK, IGF1R and mTOR inhibitors produces a profound and durable suppression of cell proliferation and a stronger induction of apoptosis, resulting in marked tumor regression in three different Kras-driven lung cancer mouse models. In order to achieve strong downstream pathway inhibition even more specifically in KRAS-mutant cells and reduce potential unwanted toxicities, we used KRAS-G12C mutant inhibitors. We show that the triple combination of mTOR, IGF1R and KRAS-G12C inhibitors causes a profound and durable inhibition of the main pathways downstream RAS and greatly improves the effectiveness of ARS-1620 on KRAS-G12C mutant lung cancer cells in vitro and in mouse models. This provides a clear rationale for the design of combination treatments to enhance and extend the response to KRAS-G12C inhibitors. Citation Format: Miriam Molina-Arcas, Christopher Moore, Sareena Rana, Febe Van Maldegem, Edurne Mugarza, Pablo Romero-Clavijo, Stuart Horswell, David Hancock, Julian Downward. Development of combination therapies to potentiate the impact of KRAS-G12C inhibitors in lung cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B073. doi:10.1158/1535-7163.TARG-19-B073

Summary RAC1 P29 is the third most commonly mutated codon in human cutaneous melanoma, after BRAF V600 and NRAS Q61. Here, we study the role of RAC1P29S in melanoma development and reveal that RAC1P29S activates PAK, AKT, and a gene expression program initiated by the SRF/MRTF transcriptional pathway, which results in a melanocytic to mesenchymal phenotypic switch. Mice with ubiquitous expression of RAC1P29S from the endogenous locus develop lymphoma. When expressed only in melanocytes, RAC1P29S cooperates with oncogenic BRAF or with NF1-loss to promote tumorigenesis. RAC1P29S also drives resistance to BRAF inhibitors, which is reversed by SRF/MRTF inhibitors. These findings establish RAC1P29S as a promoter of melanoma initiation and mediator of therapy resistance, while identifying SRF/MRTF as a potential therapeutic target., Graphical Abstract, Highlights • RAC1P29S activates PAK, AKT, and the SRF/MRTF transcription program in melanocytes • RAC1P29S induces a melanocytic to mesenchymal transition through SRF/MRTF and PAK • RAC1P29S cooperates with BRAF mutation or NF1 deletion to promote melanomagenesis • RAC1P29S induces resistance to BRAF inhibitors through SRF/MRTF, RAC1P29S is a common mutation in human cutaneous melanoma. Lionarons et al. show that RAC1P29S induces a melanocytic to mesenchymal switch via an SRF/MRTF-mediated gene expression program, cooperates with BRAF in melanomagenesis, and drives BRAF inhibitor resistance, which is reversed by SRF/MRTF inhibition.

The immunosuppressive protein PD-L1 is upregulated in many cancers and contributes to evasion of the host immune system. The relative importance of the tumor microenvironment and cancer cell-intrinsic signaling in the regulation of PD-L1 expression remains unclear. We report that oncogenic RAS signaling can upregulate tumor cell PD-L1 expression through a mechanism involving increases in PD-L1 mRNA stability via modulation of the AU-rich element-binding protein tristetraprolin (TTP). TTP negatively regulates PD-L1 expression through AU-rich elements in the 3' UTR of PD-L1 mRNA. MEK signaling downstream of RAS leads to phosphorylation and inhibition of TTP by the kinase MK2. In human lung and colorectal tumors, RAS pathway activation is associated with elevated PD-L1 expression. In vivo, restoration of TTP expression enhances anti-tumor immunity dependent on degradation of PD-L1 mRNA. We demonstrate that RAS can drive cell-intrinsic PD-L1 expression, thus presenting therapeutic opportunities to reverse the innately immunoresistant phenotype of RAS mutant cancers.

SummaryWe show that imatinib, nilotinib, and dasatinib possess weak off-target activity against RAF and, therefore, drive paradoxical activation of BRAF and CRAF in a RAS-dependent manner. Critically, because RAS is activated by BCR-ABL, in drug-resistant chronic myeloid leukemia (CML) cells, RAS activity persists in the presence of these drugs, driving paradoxical activation of BRAF, CRAF, MEK, and ERK, and leading to an unexpected dependency on the pathway. Consequently, nilotinib synergizes with MEK inhibitors to kill drug-resistant CML cells and block tumor growth in mice. Thus, we show that imatinib, nilotinib, and dasatinib drive paradoxical RAF/MEK/ERK pathway activation and have uncovered a synthetic lethal interaction that can be used to kill drug-resistant CML cells in vitro and in vivo.

Oncogenic BRAF is a critical driver of proliferation and survival and is thus a validated therapeutic target in cancer. We have developed a potent inhibitor, termed 1t (CCT239065), of the mutant protein kinase, V600EBRAF. 1t inhibits signaling downstream of V600EBRAF in cancer cells, blocking DNA synthesis, and inhibiting proliferation. Importantly, we show that 1t is considerably more selective for mutated BRAF cancer cell lines compared with wild-type BRAF lines. The inhibitor is well tolerated in mice and exhibits excellent oral bioavailability (F = 71%). Suppression of V600EBRAF-mediated signaling in human tumor xenografts was observed following oral administration of a single dose of 1t. As expected, the growth rate in vivo of a wild-type BRAF human tumor xenograft model is unaffected by inhibitor 1t. In contrast, 1t elicits significant therapeutic responses in mutant BRAF–driven human melanoma xenografts. Cancer Res; 70(20); 8036–44. ©2010 AACR.

Oncogenic mutations in KRAS are frequent in non-small cell lung cancer (NSCLC) and have been associated with poor prognosis and resistance to existing therapies. Thus, new therapeutic strategies are needed to treat these tumors. We have previously shown that NSCLC cells harboring KRAS mutations are more sensitive to inhibition of KRAS downstream effectors MEK and RAF and to treatment with IGF1R inhibitors than their wild-type counterparts. In order to identify complementary targets for the improvement of IGF1R and/or MEK targeting therapies, we performed a whole-genome shRNA screen in KRAS-mutant NSCLC cells. Interestingly, the list of sensitizers to IGF1R inhibitors included several genes encoding components of the mTOR pathway. Viability assays in a panel of lung cancer cell lines confirmed that combinations of IGF1R inhibitors with mTOR inhibitors, both rapalogs and kinase inhibitors, resulted in a synergistic anti-proliferative effect in KRAS-mutant NSCLC cells. Mechanistic investigations demonstrated some differences between the effects of rapalogs and mTOR kinase inhibitors although, in both cases, mTOR inhibitors increased IGF1R and AKT phosphorylation. Combination with IGF1R inhibitors blocked the reactivation of the PI3K pathway resulting in a robust suppression of PI3K and mTORC1 signaling. Notably, the inhibition of these signaling pathways was stronger in KRAS-mutant cells than in wild-type cells. Addition of a MEK inhibitor to the combination produced a more profound and durable suppression of cell proliferation and a stronger induction of apoptosis. Finally, we validated the different drug combinations in mouse models of KRAS-induced NSCLC. Results showed that the three-drug combination produced a marked tumor regression in a NSCLC mouse model driven by mutant Kras and p53 loss-of-function and also in urethane-induced lung tumors. These findings suggest potential novel therapeutic strategies for NSCLC tumors harboring KRAS mutations. Citation Format: Miriam Molina-Arcas, Christopher Moore, Sareena Rana, Febe van Maldegem, Stuart Horswell, David Hancock, Julian Downward. Identification of new combination therapies for lung tumors harboring KRAS mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2987.

Introduction Oncogenic mutations in KRAS are frequent in non-small cell lung cancer (NSCLC) and have been associated with poor prognosis and resistance to existing therapies. We have previously shown that NSCLC cells harbouring KRAS mutations are more sensitive than their wild-type counterparts to inhibition of KRAS downstream effectors MEK and RAF and to treatment with IGF1R inhibitors. Material and methods In order to identify complementary targets for the improvement of IGF1R and/or MEK targeting therapies, we performed a whole-genome shRNA screen with KRAS-mutant NSCLC cells. Validation was performed using shRNAs and small molecule inhibitors in a panel of NSCLC cell lines. In vivo efficacy of drug combinations was measured in mouse models of Kras-induced NSCLC using CT scanning. Results and discussions The list of sensitizers to IGF1R inhibitors included several genes encoding components of the mTOR pathway. Viability assays in a panel of lung cancer cell lines confirmed that combining IGF1R inhibitors with mTOR inhibitors, both rapalogs and kinase inhibitors, resulted in a synergistic anti-proliferative effect in KRAS-mutant NSCLC cells. Mechanistic investigations demonstrated that IGF1R inhibitors blocked reactivation of the PI3K pathway induced by mTOR inhibition, resulting in a robust suppression of PI3K and mTORC1 signalling. Addition of a MEK inhibitor to the combination produced a more profound and durable suppression of cell proliferation and a stronger induction of apoptosis by inhibiting the main downstream pathways controlled by KRAS. Notably, the inhibition of these signalling pathways was stronger in KRAS-mutant cells than in wild-type cells. In order to achieve strong downstream pathway inhibition even more specifically in KRAS-mutant cells, we used the KRAS-G12C mutant inhibitor, ARS-1620. Interestingly, addition of mTOR and IGF1R inhibitors vastly increases effectiveness of the KRAS-G12C inhibitor. Finally, we validated the drug combinations in mouse models of KRAS-induced NSCLC. Results showed that combined mTOR, IGF1R and MEK inhibition produced a marked tumour regression in a NSCLC mouse model driven by mutant Kras and p53 loss-of-function and also in urethane-induced lung tumours. Conclusion We have demonstrated that a profound inhibition of the main pathways downstream KRAS is needed to achieve a durable suppression of cell viability in NSCLC cells harbouring KRAS mutations. These findings suggest potential novel therapeutic strategies for KRAS mutant NSCLC tumours.

Purpose: Expression of aminopeptidase N/CD13 can be detected in several solid tumor types. Thus far, the role of CD13 in ovarian cancer has not been studied. We have investigated the expression pattern and biological function of CD13 in ovarian cancer. Experimental Design: First, we studied the expression of CD13 in ovarian cancer tissue of 15 patients representing three different histological types (5 patients each) by immunohistochemistry. We then stably transfected the IGROV-1 human ovarian cancer cell line with a CD13 expression vector and examined the biological effect of CD13 in vitro and in vivo. Results: The expression of CD13 in ovarian cancer was associated with the histological subtype: CD13 expression in tumor cells was observed in 80–100% of the patients with a serous or mucinous carcinoma and in only 20% of the clear cell carcinoma patients. In all patients’ tumor samples, CD13-positive blood vessels were present. CD13 overexpression in IGROV-1 cells did not affect in vitro cell growth and sensitivity to doxorubicin, cisplatin, or gemcitabine. CD13 overexpression reduced invasion in Matrigel, which appeared to be independent of the aminopeptidase activity of CD13. Furthermore, the growth rate of IGROV-1/CD13 xenografts was reduced. The area of the vessel lumens was enlarged in a small percentage of vessels in the CD13-overexpressing xenografts. In addition, the CD13-overexpressing tumors were less sensitive to cisplatin. Conclusions: CD13 is expressed in tumor as well as endothelial cells in human ovarian cancer. Our results suggest that CD13 overexpression affects ovarian cancer growth, vascular architecture, and response to chemotherapy. Further elucidation of the mechanism of the observed effects of CD13 is warranted to better understand its role in the pathophysiology of ovarian cancer.

SummaryThe aminopeptidase inhibitor bestatin has been shown to have anti-angiogenic effects in a number of model systems. These effects are thought to result from inhibition of CD13 activity. Because tumor angiogenesis can evolve in a fibrin-rich stroma matrix we have studied for the first time the effects of bestatin on microvascular endothelial capillary-like tube formation in a fibrin matrix. Bestatin enhanced the formation of capillary-like tubes dose-dependently. Its effects were apparent at 8 µM; the increase was 3.7-fold at 125 µM; while high concentrations (>250 µM), that were shown to have anti-angiogenic effects in other systems, caused extensive matrix degradation. Specific CD13-blocking antibodies WM15 and MY-7, and the aminopeptidase inhibitors amastatin and actinonin also enhanced capillary-like tube formation (maximally 1.5-fold), but these effects did not reach statistical significance. The effect of bestatin was not due to a change in uPAR availability because the relative involvement of the u-PA/u-PAR activity was not altered by bestatin. In view of the present findings we hypothesize that aminopeptidases other than CD13 predominantly contribute to the observed pro-angiogenic effect of bestatin in a fibrin matrix. The identification of this novel effect of bestatin is important in the light of the proposed use of bestatin as anti-angiogenic and/or anti-tumor agent.

© 2015 Pender et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Droplet digital PCR (ddPCR) can be used to detect low frequency mutations in oncogenedriven lung cancer. The range of KRAS point mutations observed in NSCLC necessitates a multiplex approach to efficient mutation detection in circulating DNA. Here we report the design and optimisation of three discriminatory ddPCR multiplex assays investigating nine different KRAS mutations using PrimePCRddPCRMutation Assays and the Bio-Rad QX100 system. Together these mutations account for 95% of the nucleotide changes found in KRAS in human cancer. Multiplex reactions were optimised on genomic DNA extracted from KRAS mutant cell lines and tested on DNA extracted from fixed tumour tissue from a cohort of lung cancer patients without prior knowledge of the specific KRAS genotype. The multiplex ddPCR assays had a limit of detection of better than 1 mutant KRAS molecule in 2,000 wild-type KRAS molecules, which compared favourably with a limit of detection of 1 in 50 for next generation sequencing and 1 in 10 for Sanger sequencing. Multiplex ddPCR assays thus provide a highly efficient methodology to identify KRAS mutations in lung adenocarcinoma.

Microdroplet digital PCR can be used to detect low frequency mutations in oncogene-driven lung cancer. Detection of circulating tumour DNA in plasma can be limited by paucity of material, particularly during response to anti-cancer therapy. The range of KRAS point mutations observed in NSCLC necessitates a multiplex approach for efficient mutation detection in circulating DNA. We designed and optimised 3 droplet digital PCR multiplex assays investigating 9 different KRAS mutations using PrimePCR™ ddPCR™ Mutation Assays and the Bio-Rad QX100 system. DNA was extracted from FFPE tissue and plasma from patients with advanced lung adenocarcinoma and was analysed to assess for the presence of these KRAS activating mutations. Multiple sub-clonal KRAS mutant populations were detectable in both tissue and circulating tumour DNA at low frequency (up to 0.1%). Similar KRAS allele frequency was observed using multiplex or duplex assays (r2 = 0.99). Sub-clonal population representation varied over the disease course. Multiplex microdroplet digital PCR assays can be adapted to be used to efficiently identify tissue and circulating KRAS mutations in advanced lung adenocarcinoma. Variation in sub-clonal populations between tissue and plasma, and at different time points over the disease course, illustrates the potential use of circulating DNA analysis as a more readily accessible, non-invasive and accurate representation of the molecular profile of NSCLC throughout treatment. Citation Format: Alexandra Pender, Isaac Garcia-Murillas, Sareena Rana, David Gonzalez de Castro, Nicholas Turner, Sanjay Popat, Julian Downward. A novel multiplex droplet digital PCR approach to KRAS mutation detection in circulating tumor DNA. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2408. doi:10.1158/1538-7445.AM2015-2408

The protein kinase B-RAF is mutated in approximately 7% of human cancers. Most mutations are activating, but, surprisingly, a small number have reduced kinase activity. However, the latter can still stimulate cellular signaling through the MEK-ERK pathway because they activate the related family member C-RAF. We examine the mechanism underlying C-RAF activation by B-RAF. We show that C-RAF is activated in the cytosol in a RAS-independent manner that requires activation segment phosphorylation and binding of 14-3-3 to C-RAF. We show that wild-type B-RAF forms a complex with C-RAF in a RAS-dependent manner, whereas the mutants bind independently of RAS. Importantly, we show that wild-type B-RAF can also activate C-RAF. Our data suggest that B-RAF activates C-RAF through a mechanism involving 14-3-3 mediated heterooligomerization and C-RAF transphosphorylation. Thus, we have identified a B-RAF-C-RAF-MEK-ERK cascade that signals not only in cancer but also in normal cells.