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cMyc and ERK activity are associated with resistance to ALK inhibitory treatment in glioblastoma

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Abstract

Background

Anaplastic lymphoma kinase (ALK) is expressed in ~ 60% of glioblastomas and conveys tumorigenic functions. Therefore, ALK inhibitory strategies with alectinib are conceivable for patients with glioblastoma. The aims of this preclinical study were to investigate efficacy as well as to understand and potentially overcome primary and acquired resistance mechanisms of alectinib in glioblastoma.

Methods

Efficacy of alectinib was analyzed dependent on ALK expression in different glioblastoma initiating cells and after lentiviral knockdown of ALK. Alectinib resistant cells were generated by continuous treatment with increasing alectinib doses over 3 months. M-RNA, phospho-protein and protein regulation were analyzed to decipher relevant pathways associated to treatment or resistance and specifically inhibited to evaluate rational salvage therapies.

Results

Alectinib reduced clonogenicity and proliferation and induced apoptosis in ALK expressing glioblastoma initiating cells, whereas cells without ALK expression or after ALK depletion via knockdown showed primary resistance against alectinib. High expression of cMyc and activation of the ERK1/2 pathway conferred resistance against alectinib in ALK expressing glioblastoma cells. Pharmacological inhibition of these pathways by cMyc inhibitor or MEK inhibitor, trametinib, overcame alectinib resistance and re-sensitized resistant cells to continued alectinib treatment. The combination of alectinib with radiotherapy demonstrated synergistic effects in inhibition of clonogenicity in non-resistant and alectinib resistant glioblastoma cells.

Conclusion

The data offer rationales for alectinib treatment in ALK expressing glioblastoma and for the use of ALK expression status as potential biomarker for alectinib treatment. In addition, the results propose MEK inhibition or radiotherapy as reasonable salvage treatments after acquired alectinib resistance.

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Funding

L.S. was funded by the German Cancer Aid while performing this study (Funding No. 70112464). N2M2 is funded by the German Cancer Aid (7011980) and the resistance studies by DFG SFB 1389 TP A03 to W.W. and T.K.

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Authors and Affiliations

  1. Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Anne Berberich, Lara-Marie Schmitt, Petra Rübmann, Nanina Hucke, Pauline Latzer, Dieter Lemke, Tobias Kessler & Wolfgang Wick

  2. Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany

    Anne Berberich, Lara-Marie Schmitt, Nanina Hucke, Dieter Lemke, Tobias Kessler, Michael Platten & Wolfgang Wick

  3. Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Stefan Pusch

  4. Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany

    Stefan Pusch

  5. Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Thomas Hielscher

  6. Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Bernd Heßling

  7. Clinical Cooperation Unit, Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Michael Platten

  8. Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Michael Platten

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  1. Anne Berberich
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  2. Lara-Marie Schmitt
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Correspondence to Wolfgang Wick.

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Berberich, A., Schmitt, LM., Pusch, S. et al. cMyc and ERK activity are associated with resistance to ALK inhibitory treatment in glioblastoma. J Neurooncol 146, 9–23 (2020). https://doi.org/10.1007/s11060-019-03348-z

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