The insulin-like growth factor-1 receptor (IGF-1R) and ErbB family of receptors are receptor tyrosine kinases that play important roles in cancer. Lack of response and resistance to therapies targeting ErbB receptors occur and are often associated with activation of the IGF-1R pathway. Combinations of agents that inhibit IGF-1R and ErbB receptors have been shown to synergistically block cancer cell proliferation and xenograft tumor growth. To determine the mechanism by which targeting both IGF-1R and ErbB receptors causes synergistic effects on cell growth and survival, we investigated the effects of combinations of selective IGF-1R and ErbB kinase inhibitors on proliferative and apoptotic signaling. We identified A431 squamous cell carcinoma cells as most sensitive to combinations of ErbB and IGF-1R inhibitors. The inhibitor combinations resulted in not only blockade of A431 cell proliferation, but also induced apoptosis, which was not seen with either agent alone. Upon examining phosphorylation states and expression levels of proteins in the IGF-1R and ErbB signaling pathways, we found a correlation between the ability of combinations to inhibit proliferation and to decrease levels of phosphorylated Akt and cyclin D1. In addition, the massive cell death induced by combined IGF-1R/ErbB inhibition was associated with Mcl-1 reduction and Bax activation. Thus, targeting both IGF-1R and ErbB receptors simultaneously results in cell cycle arrest and apoptosis through combined effects on Akt, cyclin D1, and Bax activation.
IGF-1R2 function is important for cellular processes that are activated in cancer cells, including cell proliferation, survival, metastasis, and invasion (1-4). Transformation of cells by several oncogenes has been shown to require IGF-1R function (2, 5), and anchorage-independent growth (3) and survival of cancer cells in response to cellular stress (5) can both be mediated by the IGF-1R. IGF-1R stimulates cell proliferation and survival through activation of the extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) and Akt pathways. Upon binding of IGF-1 or IGF-2 to the IGF-1R, the receptor becomes autophosphorylated on several tyrosine residues. These phosphotyrosines serve as binding sites for adaptor proteins, including insulin receptor substrate (IRS)-1-4 and Shc, which are then phosphorylated by the activated receptor. Phosphorylated IRS and Shc in turn recruit Grb2/SOS, which leads to activation of the MAPK pathway, and the p85 subunit of phosphatidylinositol 3-kinase, resulting in phosphatidylinositol 3,4,5-trisphosphate production and Akt activation (3, 6, 7). The MAPK and Akt pathways regulate levels of cell cycle proteins like cyclin D1 and p27 to cause increased cell proliferation (8) and decrease apoptosis by phosphorylating the proapoptotic protein, Bad, which results in its sequestration by 14-3-3 (9). Antibodies that target IGF-1R and one small molecule IGF-1R inhibitor are undergoing clinical trials, and several other IGF-1R small molecule inhibitors ...