Journal Article

Targeting activated PI3K/mTOR signaling overcomes acquired resistance to CDK4/6-based therapies in preclinical models of hormone receptor-positive breast cancer

O’Brien, Neil A., Luo, Tong, Hurvitz, Sara A., Rose, Kristine, Ayala, Raul, Su, Faye, Salgar, Suruchi, McDermott, Martina S. J., Conklin, Dylan, Chau, Kevin, Slamon, Dennis J., DiTomaso, Emmanuelle, Hirawat, Samit, Linnartz, Ronald, Babbar, Naveen, Gaither, Alex

2020

Overview

Background Combined targeting of CDK4/6 and ER is now the standard of care for patients with advanced ER+/HER2− breast cancer. However, acquired resistance to these therapies frequently leads to disease progression. As such, it is critical to identify the mechanisms by which resistance to CDK4/6-based therapies is acquired and also identify therapeutic strategies to overcome resistance. Methods In this study, we developed and characterized multiple in vitro and in vivo models of acquired resistance to CDK4/6-based therapies. Resistant models were screened by reverse phase protein array (RPPA) for cell signaling changes that are activated in resistance. Results We show that either a direct loss of Rb or loss of dependence on Rb signaling confers cross-resistance to inhibitors of CDK4/6, while PI3K/mTOR signaling remains activated. Treatment with the p110α-selective PI3K inhibitor, alpelisib (BYL719), completely blocked the progression of acquired CDK4/6 inhibitor-resistant xenografts in the absence of continued CDK4/6 inhibitor treatment in models of both PIK3CA mutant and wild-type ER+/HER2− breast cancer. Triple combination therapy against PI3K:CDK4/6:ER prevented and/or delayed the onset of resistance in treatment-naive ER+/HER2− breast cancer models. Conclusions These data support the clinical investigation of p110α-selective inhibitors of PI3K, such as alpelisib, in patients with ER+/HER2− breast cancer who have progressed on CDK4/6:ER-based therapies. Our data also support the investigation of PI3K:CDK4/6:ER triple combination therapy to prevent the onset of resistance to the combination of endocrine therapy plus CDK4/6 inhibition.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: 1-Phosphatidylinositol 3-kinase / Alpelisib / Animals / Antineoplastic agents / Biomedical and Life Sciences / Biomedicine / Breast cancer / Breast Neoplasms - drug therapy / Breast Neoplasms - metabolism / Breast Neoplasms - pathology / Cancer Research / Cancer therapies / Cell cycle / Cell Line, Tumor / Cross-resistance / Cyclin-dependent kinase 4 / Cyclin-Dependent Kinase 4 - antagonists & inhibitors / Cyclin-Dependent Kinase 6 - antagonists & inhibitors / Drug Evaluation, Preclinical / Drug Resistance, Neoplasm / Endocrine therapy / ErbB-2 protein / Estrogen Receptor alpha - antagonists & inhibitors / Female / Health aspects / Humans / Kinases / Laboratories / Metastasis / Mice, Nude / Molecular Targeted Therapy / Oncology / Palbociclib / Patients / Penicillin G / Phosphatidylinositol 3-Kinases - chemistry / Phosphatidylinositol 3-Kinases - metabolism / Pregnancy / Protein arrays / Protein Kinase Inhibitors - pharmacology / Proteins / Research Article / Signal Transduction / Software / Surgical Oncology / TOR protein / TOR Serine-Threonine Kinases - antagonists & inhibitors / TOR Serine-Threonine Kinases - metabolism / Translational / Xenograft Model Antitumor Assays / Xenografts