Project-002

受体酪氨酸激酶(RTK)抑制剂已经彻底改变了几种癌症的治疗方法，但 获得性耐药的最终出现仍然是临床益处的主要限制。我们最近的研究 小组和其他人已经表明获得性耐药通常以广泛的肿瘤为特征 异质性，多种耐药机制同时出现在不同的肿瘤亚克隆中 一个单独的病人。这种异质性带来了巨大的治疗障碍，因为设计的治疗方法 克服一种特定的抗性机制可能无法抑制含有其他抗性机制的亚克隆 耐药机制，导致克隆生长和治疗失败。制定战略并建立模型，以 克服对RTK抑制剂的异质性耐药性，我们将对 对MET抑制的获得性抗性。MET是一种关键的RTK，具有越来越重要的治疗意义， MET抑制剂在~4%的胃食道癌(GEC)中观察到显著的反应 ~5%的非小细胞肺癌(NSCLC)患者存在MET 14外显子跳跃。我们会 采用系统的液体活检平台进行循环肿瘤DNA分析，并结合系列肿瘤 活组织检查和快速尸检程序，以确定获得者的分子景观和异质性 对MET抑制的抗性。通过详细的机制研究，我们将尝试找出共同的 多个抗性机制汇聚在一起的信令节点，这可能代表“通用” 目标是同时拦截多种异质抗性机制。我们还将评估 序贯抑制策略与实时ctDNA监测相结合的潜力，以克服 不共享公共信号输出的抗性机制。这些方法有可能 创造了在获得性耐药背景下克服肿瘤异质性的新标准，我们 预期这些研究定义的原则将广泛适用于其他RTK抑制剂范例。

Receptor Tyrosine Kinase (RTK) inhibitors have revolutionized the treatment of several cancer types, but the eventual emergence of acquired resistance remains a major limitation of clinical benefit. Recent studies by our group and others have shown that acquired resistance is often characterized by extensive tumor heterogeneity, with multiple resistance mechanisms emerging simultaneously in distinct tumor subclones within an individual patient. This heterogeneity presents a formidable therapeutic obstacle, as therapies designed to overcome one specific resistance mechanism may be unable to suppress subclones harboring other resistance mechanisms, leading to clonal outgrowth and treatment failure. To develop and model strategies to overcome heterogeneous resistance to RTK inhibitors, we will perform a comprehensive assessment of acquired resistance to MET inhibition. MET is a critical RTK that is of growing therapeutic importance, with dramatic responses observed with MET inhibitors in the ~4% of gastroesophageal cancers (GEC) with MET amplification and ~5% of non-small cell lung cancer (NSCLC) patients with MET exon 14 skipping. We will employ a systematic liquid biopsy platform for circulating tumor DNA analysis, coupled with serial tumor biopsies, and a rapid autopsy program, to define the molecular landscape and heterogeneity of acquired resistance to MET inhibition. Through detailed mechanistic studies, we will attempt to identify common signaling nodes upon which multiple resistance mechanisms converge, which may represent “universal” targets to intercept multiple heterogeneous resistance mechanisms simultaneously. We will also evaluate the potential for sequential inhibition strategies coupled with real-time ctDNA monitoring to overcome multiple resistance mechanisms that do not share a common signaling output. These approaches have the potential to create a new standard for surmounting tumor heterogeneity in the setting of acquired resistance, and we anticipate that principles defined by these studies will be broadly applicable to other RTK inhibitor paradigms.