Cetuximab Resistance in Squamous Carcinomas of the Upper Aerodigestive Tract Is Driven by Receptor Tyrosine Kinase Plasticity: Potential for mAb Mixtures

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  • Ida Kjær
  • Trine Lindsted
  • Camilla Fröhlich
  • Olsen, Jesper Velgaard
  • Ivan David Horak
  • Michael Kragh
  • Mikkel Wandahl Pedersen

Squamous cell carcinomas (SCC) arising in upper parts of the aero-digestive tract (UAT) are among the leading causes of death worldwide. The epidermal growth factor receptor (EGFR) has been found to play an essential role in driving the malignancy of SCCUAT, but despite this, clinical results using a range of different EGFR- targeted agents have been disappointing. Cetuximab is currently the only EGFR-targeted agent approved by the FDA for treatment of SCCUAT. However, intrinsic and acquired cetuximab resistance is a major problem for effective therapy. Thus, a better understanding of the mechanisms responsible for cetuximab resistance is valuable for development of the next generation of antibody therapeutics. In order to better understand the underlying mechanisms of cetuximab resistance in SCCUAT, we established from cetuximab-sensitive models, cell lines with acquired resistance to cetuximab by continuous selective pressure in vitro and in vivo. Our results show that resistant clones maintain partial dependency on EGFR and that RTK plasticity mediated by HER3 and IGF1R plays an essential role. A multi-target mAb mixture against EGFR, HER3, and IGF1R was able to overcome cetuximab resistance in vitro. To our surprise, these findings could be extended to include SCCUAT cell lines with intrinsic resistance to cetuximab, suggesting that the triad consisting of EGFR, HER3, and IGF1R plays a key role in SCCUAT. Our results thus provide a rationale for simultaneous targeting of EGFR, HER3, and IGF1R in SCCUAT.

Original languageEnglish
JournalMolecular Cancer Therapeutics
Volume15
Issue number7
Pages (from-to)1614-1626
Number of pages13
ISSN1535-7163
DOIs
Publication statusPublished - Jul 2016

ID: 161941779