Protective autophagy elicited by RAF→MEK→ERK inhibition suggests a treatment strategy for RAS-driven cancers
Protective autophagy elicited by RAF→MEK→ERK inhibition suggests a treatment strategy for RAS-driven cancers
Pancreatic ductal adenocarcinoma (PDA) was responsible for ~ 44,000 deaths in the United States in 2018 and is the epitome of a recalcitrant cancer driven by a pharmacologically intractable oncoprotein, KRAS1-4. Downstream of KRAS, the RAF→MEK→ERK signaling pathway plays a central role in pancreatic carcinogenesis5. However, paradoxically, inhibition of this pathway has provided no clinical benefit to patients with PDA6. Here we show that inhibition of KRAS→RAF→MEK→ERK signaling elicits autophagy, a process of cellular recycling that protects PDA cells from the cytotoxic effects of KRAS pathway inhibition. Mechanistically, inhibition of MEK1/2 leads to activation of the LKB1→AMPK→ULK1 signaling axis, a key regulator of autophagy. Furthermore, combined inhibition of MEK1/2 plus autophagy displays synergistic anti-proliferative effects against PDA cell lines in vitro and promotes regression of xenografted patient-derived PDA tumors in mice. The observed effect of combination trametinib plus chloroquine was not restricted to PDA as other tumors, including patient-derived xenografts (PDX) of NRAS-mutated melanoma and BRAF-mutated colorectal cancer displayed similar responses. Finally, treatment of a patient with PDA with the combination of trametinib plus hydroxychloroquine resulted in a partial, but nonetheless striking disease response. These data suggest that this combination therapy may represent a novel strategy to target RAS-driven cancers.
- University of Utah United States
- University of Utah Health Care United States
- UNIVERSITY OF UTAH
- Claude Bernard University Lyon 1 France
- French Institute of Health and Medical Research France
Mitogen-Activated Protein Kinase Kinases, Proto-Oncogene Proteins B-raf, CA-19-9 Antigen, MAP Kinase Signaling System, Pyridones, Chloroquine, Mice, SCID, Pyrimidinones, Xenograft Model Antitumor Assays, Article, Pancreatic Neoplasms, Cell Line, Tumor, Autophagy, ras Proteins, Animals, Humans, Protein Kinase Inhibitors
Mitogen-Activated Protein Kinase Kinases, Proto-Oncogene Proteins B-raf, CA-19-9 Antigen, MAP Kinase Signaling System, Pyridones, Chloroquine, Mice, SCID, Pyrimidinones, Xenograft Model Antitumor Assays, Article, Pancreatic Neoplasms, Cell Line, Tumor, Autophagy, ras Proteins, Animals, Humans, Protein Kinase Inhibitors
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