Journal Article

Mutations in ALK signaling pathways conferring resistance to ALK inhibitor treatment lead to collateral vulnerabilities in neuroblastoma cells

Dorel, Mathurin, Chesler, Louis, Molenaar, Jan Jasper, Kloft, Charlotte, da Costa, Barbara Martins, Hughes, Deborah, Dorado-Garcia, Heathcliff, Rodriguez-Fos, Elias, Boettcher, Michael, Koutroumanidou, Eleni, Lang, Peter, Calton, Elizabeth, Fyle, Elicia, Eggert, Angelika, Barone, Giuseppe, Eising, Selma, McGearey, Aleixandria, Proszek, Paula, Henssen, Anton George, Tucker, Elizabeth, Stankunaite, Reda, Rosswog, Carolina, Barker, Karen, Jain, Neha, Deubzer, Hedwig Elisabeth, Winkler, Annika, Ober, Kim, Hertwig, Falk, Hubank, Mike, Fischer, Matthias, Anderson, John, Blüthgen, Nils, Schulte, Johannes Hubertus, Künkele, Annette, Berlak, Mareike, Carter, Paul

2022

Overview

Background Development of resistance to targeted therapies has tempered initial optimism that precision oncology would improve poor outcomes for cancer patients. Resistance mechanisms, however, can also confer new resistance-specific vulnerabilities, termed collateral sensitivities. Here we investigated anaplastic lymphoma kinase (ALK) inhibitor resistance in neuroblastoma, a childhood cancer frequently affected by activating ALK alterations. Methods Genome-wide forward genetic CRISPR-Cas9 based screens were performed to identify genes associated with ALK inhibitor resistance in neuroblastoma cell lines. Furthermore, the neuroblastoma cell line NBLW-R was rendered resistant by continuous exposure to ALK inhibitors. Genes identified to be associated with ALK inhibitor resistance were further investigated by generating suitable cell line models. In addition, tumor and liquid biopsy samples of four patients with ALK -mutated neuroblastomas before ALK inhibitor treatment and during tumor progression under treatment were genomically profiled. Results Both genome-wide CRISPR-Cas9-based screens and preclinical spontaneous ALKi resistance models identified NF1 loss and activating NRAS Q61K mutations to confer resistance to chemically diverse ALKi. Moreover, human neuroblastomas recurrently developed de novo loss of NF1 and activating RAS mutations after ALKi treatment, leading to therapy resistance. Pathway-specific perturbations confirmed that NF1 loss and activating RAS mutations lead to RAS-MAPK signaling even in the presence of ALKi. Intriguingly, NF1 loss rendered neuroblastoma cells hypersensitive to MEK inhibition. Conclusions Our results provide a clinically relevant mechanistic model of ALKi resistance in neuroblastoma and highlight new clinically actionable collateral sensitivities in resistant cells.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: ALK / Anaplastic Lymphoma Kinase - genetics / Antimitotic agents / Antineoplastic agents / Biomedical and Life Sciences / Biomedicine / Biopsy / Cancer Research / Cancer therapies / Care and treatment / Cell culture / Cell Line, Tumor / Child / Children / Cloning / CRISPR / CRISPR screening / Development and progression / Enzyme inhibitors / Gene expression / Genetic aspects / Genomes / Genomics / Humans / Kinases / Lymphoma / MAP kinase / Mutation / Neuroblastoma / Neuroblastoma - drug therapy / Neuroblastoma - genetics / Neuroblastoma - pathology / Neuroblastoma cells / NF1 / Non-Hodgkin's lymphomas / NRAS / Oncology / Patients / Precision Medicine / Protein Kinase Inhibitors - pharmacology / Protein Kinase Inhibitors - therapeutic use / Protein-tyrosine kinase / Resistance / Signal Transduction / Targeted cancer therapy / Tumors