Lung cancer with epidermal growth factor receptor (EGFR)-activating mutations responds favorably to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. However, 25% to 30% of patients with EGFR-activating mutations show intrinsic resistance, and the responders invariably acquire resistance to gefitinib. Here, we showed that hepatocyte growth factor (HGF), a ligand of MET oncoprotein, induces gefitinib resistance of lung adenocarcinoma cells with EGFR-activating mutations by restoring the phosphatidylinositol 3-kinase/Akt signaling pathway via phosphorylation of MET, but not EGFR or ErbB3. Strong immunoreactivity for HGF in cancer cells was detected in lung adenocarcinoma patients harboring EGFR-activating mutations, but no T790M mutation or MET amplification, who showed intrinsic or acquired resistance to gefitinib. The findings indicate that HGF-mediated MET activation is a novel mechanism of gefitinib resistance in lung adenocarcinoma with EGFR-activating mutations. Therefore, inhibition of HGF-MET signaling may be a considerable strategy for more successful treatment with gefitinib. [Cancer Res 2008;68(22):9479-87]

Purpose: Lung cancers with epidermal growth factor receptor (EGFR)-activating mutations show good clinical response to gefitinib and erlotinib, selective tyrosine kinase inhibitors (TKI) to EGFR, but these tumors invariably develop drug resistance. Host stromal cells have been found to have a considerable effect on the behavior of cancer cells. Little is known, however, about the role of host cells on the sensitivity of cancer cells to receptor TKIs. We have therefore assessed the effect of crosstalk between stromal cells and lung cancer cells harboring EGFR mutations on susceptibility to EGFR-TKIs. Experimental Design: We evaluated the gefitinib sensitivity of lung cancer cells with EGFR-activating mutations, PC-9 and HCC827, when cocultured with fibroblasts and coinjected into severe combined immunodeficient mice. We also examined the effect of lung cancer cells to fibroblast recruitment. Results: Both human fibroblast cell lines and primary cultured fibroblasts produced various levels of hepatocyte growth factor (HGF). Lung cancer cells markedly recruited fibroblasts. The lung cancer cells became resistant to EGFR-TKIs when cocultured in vitro with HGF-producing fibroblasts and coinjected into severe combined immunodeficient mice. Importantly, combined use of gefitinib plus anti-HGF antibody or the HGF antagonist, NK4, successfully overcame the fibroblast-induced EGFR-TKI resistance both in vitro and in vivo. Colocalization of fibroblasts and HGF was detected in both xenograft tumors in mouse model and lung cancer patient specimens. Conclusions: These findings indicate that crosstalk to stromal fibroblasts plays a critical role in lung cancer resistance to EGFR-TKIs and may be an ideal therapeutic target in lung cancer with EGFR-activating mutations. ( Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for ∼80% of lung cancers. The median survival of patients with metastatic NSCLC treated with the most active combination of conventional chemotherapy agents is 8 to 10 months (1, 2). Therefore, recent therapeutic strategies for NSCLC have focused on the development of molecular targeted agents.Epidermal growth factor receptor (EGFR), a member of a family of closely related growth factor receptor tyrosine kinases, is expressed in a majority of NSCLCs and has been an attractive target for the development of therapeutic agents. Almost 90% of these somatic activating mutations in EGFR consist of inframe deletions in exon 19 and L858R point mutations in exon 21 (3, 4). These mutations induce oncogenic activity and are closely correlated with sensitivity to small-molecule EGFR tyrosine kinase inhibitors (TKI), such as gefitinib and erlotinib. These mutations are more frequently present in females than in males, in nonsmokers than in smokers, in East Asians than in other ethnic groups, and in adenocarcinomas than in other tumor types (5). Several prospective clinical trials have shown that 70% to 75% of patients with tumors harboring these mu...

Radioresistance is a major challenge during the treatment of breast cancer. A further understanding of the mechanisms of radioresistance could provide strategies to address this challenge. In our study, we compared the expression of miR- Breast cancer is the most common cancer in women worldwide. 1 Radiotherapy is an important part of the treatment in most patients receiving breast-conserving surgery and displays significant clinical benefits, such as decreasing the risk of local recurrence and reducing the risk of mortality due to breast cancer. 2 However, for certain subtypes of breast cancer (e.g., basal-like), the local and regional control remains unsatisfactory. A major reason for this failure in treatment may be due to its radioresistance. 3-5 Therefore, understanding the molecular mechanisms involved in the radioresistance of breast tumors may lead to improved clinical outcomes.Autophagy is a cellular process that involves selfdegradation and recycling of macromolecules and cellular organelles. 6,7 It is, in most circumstances, a prosurvival mechanism under stressful conditions. Autophagy has been implicated in a variety of human diseases. [7][8][9] Similar to the situation in normal cells, autophagy is also critical for tumor cells to survive stressful conditions, and thus has been implicated in tumor resistance to chemotherapy and radiotherapy. [10][11][12][13] MicroRNAs (miRNAs) regulate a variety of biological processes, including cell proliferation, differentiation and invasion. 14 Dysregulation of miRNAs has been reported to contribute to cancer, 15,16 and implicated in chemoresistance and radioresistance via modulation of autophagy. 10,13 Such findings are not surprising considering the fact that miRNAs are key regulators of autophagy. 17 The miR-200 family is involved in the self-renewal of cancer stem cells, 18 epithelial-to-mesenchymal transition (EMT) 19,20 and chemosensitivity. 21 Recent studies indicated that miR-200c, the prevailing member of the miR-200 family, 19,20,22,23 could sensitize cancer cells to radiation by targeting TBK1 and VEGF-VEGFR2, despite the unspecified relationship between miR-200c and autophagy. 24,25 The results from our study showed that miR-200c could sensitize breast cancer cells to radiation via a mechanism associated with inhibition of irradiation-induced autophagy.