Protective autophagy elicited by RAF→ MEK→ ERK inhibition suggests a treatment strategy for RAS-driven cancers

CG Kinsey, SA Camolotto, AM Boespflug, KP Guillen… - Nature medicine, 2019 - nature.com
CG Kinsey, SA Camolotto, AM Boespflug, KP Guillen, M Foth, A Truong, SS Schuman…
Nature medicine, 2019nature.com
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, KRAS,,–. Downstream of KRAS, the RAF→ MEK→ ERK signaling
pathway plays a central role in pancreatic carcinogenesis. However, paradoxically,
inhibition of this pathway has provided no clinical benefit to patients with PDA. Here we
show that inhibition of KRAS→ RAF→ MEK→ ERK signaling elicits autophagy, a process of …
Abstract
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, KRAS, , –. Downstream of KRAS, the RAF→MEK→ERK signaling pathway plays a central role in pancreatic carcinogenesis. However, paradoxically, inhibition of this pathway has provided no clinical benefit to patients with PDA. 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.
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