Overcoming Resistance to KIT/PDGFRA Inhibition in GIST

克服 GIST 中对 KIT/PDGFRA 抑制的耐药性

• 批准号: 8933243
• 负责人: JONATHAN Alfred FLETCHER
• 金额: $ 24.03万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-31 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8933243
• 关键词: Basic Science; Biochemical; Biological Assay; Biological Markers; Biopsy; Cell Proliferation; Cells; Clinical; Clinical Research; Clinical Trials; Combined Modality Therapy; Complement; Dana-Farber Cancer Institute; Drug resistance; Event; Exhibits; Exposure to; Extinction (Psychology); Failure; Gene Expression Profile; Gene Mutation; Genes; Genetic; Goals; Human; Imatinib; Imatinib mesylate; Intervention; MAP Kinase Gene; MEK inhibition; MEKs; Malignant Neoplasms; Measurable Disease; Metastatic Lesion; Molecular; Mutation; Oncogenic; Oral; PDGFRA gene; PDGFRB gene; Pathway interactions; Patients; Phase; Phosphoproteins; Phosphotransferases; Property; Receptor Protein-Tyrosine Kinases; Regimen; Research; Resistance; Resistance development; Signal Pathway; Signal Transduction; Specificity; Supporting Cell; Testing; Therapeutic; Translating; Translations; Treatment Efficacy; Validation; Work; Xenograft procedure; anticancer activity; bench to bedside; clinical application; clinically relevant; design; exome sequencing; functional genomics; gain of function; inhibitor/antagonist; insight; kinase inhibitor; mutant; novel; pre-clinical; preclinical study; research clinical testing; resistance mechanism; response; small hairpin RNA; success; therapeutic target; therapy development; tumor

This proposal seeks effective combination therapies that maximize GIST response to KIT/PDGFRA inhibition by concurrently targeting the biologically key MEK/MAPK pathway. Most GISTs express mutant, constitutively activated forms of the KIT or PDGFRA, and we have shown that these formerly untreatable cancers can be palliated in 80% of patients by oral single-agent therapy with imatinib mesylate. However,patients responding to imatinib have persistent measurable disease and generally develop resistance within two years of starting treatment. Therefore, more effective and broader-spectrum therapies are urgently needed. Notably, our preliminary studies show that KIT/PDGFRA imatinib resistance mechanisms vary from patient to patient, and also between metastatic lesions in a given patient, but uniformly rely upon MEK/MAPK signaling to support cell proliferation. In Aim 1, by studying MEK/MAPK signaling and response mechanisms, we will develop clinically-relevant biomarkers and - most importantly - we will identify alternate MEK-dependent therapeutic targets which might have greater specificity, in GIST, compared to MEK. In Aim 2. we will characterize mechanisms of MEKi resistance, since such studies are likely to identify biologically essential regulatory nodes in MEK/MAPK-pathways, which - like those found in Aim 1 - will be candidates as biomakers and therapeutic targets in GIST clinical trials. The collective studies in Aims 1-2, by revealing the scope of MEK/MAPK signaling in GIST, will provide the understanding needed to design more effective and less toxic clinical trials. In Aim 3 we evaluate combination therapies with imatinib and MEKi, as a strategy to inhibit downstream signals from the varied gain-of-function KIT mutations each imatinib-resistant patient, while maintaining imatinib inhibition of nonprogressing GIST subclones. This will be accomplished through a phase l/ll clinical trial of the MEK inhibitor, MEK162, combined with imatinib, in patients showing progression of metastatic GIST on imatinib or sunitinib. Through these studies, we will translate the basic science proposed in this SPORE through to clinical application.

该提案寻求有效的联合疗法，通过同时靶向生物学关键的MEK/MAPK途径，最大限度地提高GIST对KIT/PDGFRA抑制的反应。大多数GIST表达突变的、组成性激活形式的KIT或PDGFRA，我们已经证明，这些以前无法治疗的癌症可以通过口服甲磺酸伊马替尼单药治疗在80%的患者中得到缓解。然而，对伊马替尼有反应的患者具有持续的可测量的疾病，并且通常在开始治疗的两年内产生耐药性。因此，更有效和更广谱的治疗方法是 迫切需要。值得注意的是，我们的初步研究表明，KIT/PDGFRA伊马替尼耐药机制 不同的患者，也在给定患者的转移病灶之间，但一致地依赖于 MEK/MAPK信号传导以支持细胞增殖。在目的1中，通过研究MEK/MAPK信号通路， 反应机制，我们将开发临床相关的生物标志物，最重要的是，我们将 确定替代MEK依赖性治疗靶点，其在GIST中可能比MEK具有更大的特异性。在目标2中。我们将描述MEKi抗性的机制，因为这样的研究很可能鉴定MEK/MAPK途径中的生物学必需的调节节点，其-像在Aim 1中发现的那些-将作为GIST临床试验中的生物标记物和治疗靶点的候选者。目的1-2中的集体研究，通过揭示GIST中MEK/MAPK信号传导的范围，将提供 设计更有效、毒性更低的临床试验所需的理解。在目标3中， 伊马替尼和MEKi的联合治疗，作为抑制来自不同肿瘤的下游信号的策略， 每个伊马替尼耐药患者的功能获得性KIT突变，同时维持伊马替尼对非进展性 GIST亚克隆。这将通过MEK抑制剂MEK 162与伊马替尼联合治疗在伊马替尼或舒尼替尼治疗后显示转移性GIST进展的患者的I/II期临床试验来实现。通过这些研究，我们将把本SPORE中提出的基础科学转化为临床应用。