曲妥珠单抗治疗HER2阳性乳腺癌的耐药机制及新疗法探索

研究表明大约有20％的乳腺癌患者存在HER2过表达现象。HER2的异常表达及异常信号通路与乳腺癌的侵袭转移、治疗抵抗及不良预后密切相关。在临床上,对于HER2阳性的初期乳腺癌患者常联合曲妥珠单抗及化学药物治疗,但部分患者对曲妥珠单抗产生耐药。因此,研究其耐药机制对于HER2阳性乳腺癌患者的治疗、预后及新疗法的探索具有重要的临床意义。目前引起曲妥珠单抗抵抗的主要机制有：p95-HER2累积、P13K／AKT／mTOR信号异常激活、HER家族受体和IGF-1R信号增加、非受体酪氨酸激酶c-SRC活性增加等。将对上述机制及治疗HER2阳性乳腺癌的新疗法进行综述。     

曲妥珠单抗辅助或新辅助治疗HER2 阳性转移性乳腺癌的临床结果

目的:比较人表皮生长因子受体2过表达(HER2+)的患者既往接受以曲妥珠单抗为基础辅助或新辅助治疗后再次接受针曲妥珠单抗治疗的临床结果。方法:共247例(I-III期170例,IV期77例)HER2+转移性乳腺癌患者,其中首次接受曲妥珠单抗治疗患者211例(I-III期134例,IV期77例),再次接受曲妥珠单抗治疗患者36例(I-III期)。使用Cox比例风险回归和logistic回归分析首次或提前接受曲妥珠单抗治疗的患者的预后的临床结果,生存评估使用Kaplan-Meier法。结果:I-III期HER2+转移性乳腺癌患者中,未预先接受曲妥珠单抗治疗组的中位总生存期为36个月和预先接受曲妥珠单抗治疗组为28个月(危害比[HR],1.45;95%CI,1.05-2.02[P=0.012]);I-IV期HER2+转移性乳腺癌患者中,未预先使用曲妥珠单抗组的中位总生存期为37个月,客观缓解率58%;临床获益率77%;预先使用曲妥珠单抗组为25个月,客观缓解率28%;临床获益率37%;调整后的比值比为客观缓解率0.37(9%CI,0.18-0.77;P=0.010)和临床获益率0.28(95%CI,0.14-0.59;P=0.014)。单因素分析没有提前接受曲妥珠单抗治疗组中位总生存率较长(P=0.012)。多因素分析发现总生存率没有显著差异(P=0.19)。结论:当曲妥珠单抗用于转移性疾病,没有提前接受曲妥珠单抗治疗的HER2+乳腺癌患者临床结果优于提前接受曲妥珠单抗治疗的患者。     

HER2阳性乳腺癌中CD44v6的表达与曲妥珠单抗耐药的关系

目的：探讨曲妥珠单抗在治疗HER2阳性的转移性乳腺癌时,产生耐药性与CD44v6表达的相关性。方法：共66例HER2阳性转移性乳腺癌患者入组。接受曲妥珠单抗治疗的患者37例,其中18例获得了治疗前和治疗后转移性癌组织。采用免疫组化S-P法对治疗前、治疗后的不同乳腺组织进行CD44v6表达的研究。结果：CD44v6在经曲妥珠单抗治疗产生耐药的活检组织中阳性表达程度明显高于治疗前。结论：CD44v6的表达与曲妥珠单抗耐药相关。     

HER2阳性乳腺癌中CD44v6的表达与曲妥珠单抗耐药的关系

目的:探讨曲妥珠单抗在治疗HER2阳性的转移性乳腺癌时,产生耐药性与CD44v6表达的相关性。方法:共66例HER2阳性转移性乳腺癌患者入组。接受曲妥珠单抗治疗的患者37例,其中18例获得了治疗前和治疗后转移性癌组织。采用免疫组化S-P法对治疗前、治疗后的不同乳腺组织进行CD44v6表达的研究。结果:CD44v6在经曲妥珠单抗治疗产生耐药的活检组织中阳性表达程度明显高于治疗前。结论:CD44v6的表达与曲妥珠单抗耐药相关。     

曲妥珠单抗联合多西紫杉醇在HER-2 阳性晚期乳腺癌中的应用

目的:探讨曲妥珠单抗联合多西紫杉醇在HER-2阳性晚期乳腺癌中的应用。方法:收取2010年2月至2016年1月我院收治的82例HER-2阳性晚期乳腺癌患者作为研究对象,根据不同治疗方案分为观察组及对照组。观察组43例患者给予曲妥珠单抗联合多西紫杉醇治疗,多西紫杉醇以3周为1个周期连续用药4个周期,曲妥珠单抗连续使用8周~52周。对照组39例患者只给予曲妥珠单抗单药治疗。对两组患者临床疗效、临床受益反应指数以及不良反应发生情况进行观察与比较。结果:51P1察组总有效率(60.47%)高于对照组(43.59%),但差异无统计学意义(P0.05)。观察组疾病控制率(90.70%)显著高于对照组(71.79%),差异有统计学意义(P0.05)。观察组临床受益反应有效率(76.74%)显著高于对照组(41.03%)差异有统计学意义(P0.05)。两组患者不良反应无显著差异(P0.05)。结论:曲妥珠单抗联合多西紫杉醇对于HER-2阳性晚期乳腺癌有较好的临床疗效及安全性,患者临床受益高。     

高良姜素通过PTEN/AKT信号通路抑制乳腺癌发展并增加曲妥珠单抗抗肿瘤活性

本文旨在研究中药高良姜素对人乳腺癌的治疗作用,对乳腺癌治疗靶向药物曲妥珠单抗抗癌活性影响及其机制。通过建立乳腺癌肿瘤移植模型,研究高良姜素、曲妥珠单抗以及联合用药后的乳腺癌肿瘤进展,试验结束后获取组织进行免疫化学和免疫荧光分析,并进一步检测不同药物处理对细胞侵袭和转移能力的影响,通过TUNNEL法进行细胞凋亡分析,通过流式细胞术测定细胞周期,使用蛋白质印迹测定PTEN和AKT途径相关蛋白的表达,使用定量PCR测定PTEN以及AKT途径mRNA水平。结果显示,与对照组相比,高良姜素处理可以促进乳腺癌细胞中PTEN表达进而降低蛋白激酶B水平,抑制凋亡相关蛋白MDM和p53的激活,并增加Caspase-3的表达,最终抑制乳腺癌细胞的增殖并诱导细胞凋亡,而体内实验显示,高良姜素可以抑制裸鼠体内的肿瘤生长,并促进曲妥珠单抗的体内抗肿瘤活性。上述结果表明,高良姜素通过调控PTEN/AKT抑制肿瘤细胞的增殖,诱导细胞凋亡,抑制乳腺癌肿瘤进展,同时增加曲妥珠单抗抗癌活性。     

无岩藻糖修饰曲妥珠单抗的研究进展

乳腺癌是女性常见癌症中致死率最高的恶性肿瘤疾病之一,严重危害女性的生命健康。其中,以HER2阳性乳腺癌发病率和致死率最高。曲妥珠单抗在治疗HER2阳性乳腺癌上具有显著的临床疗效,然而由于患者耐药性的产生、HER2表达异常、用药成本高等原因,曲妥珠单抗在实际临床使用过程中存在极大的局限性。研究发现敲除抗体Fc段寡糖的核心岩藻糖可明显提高曲妥珠单抗的ADCC效应,改善其临床疗效。综述了如何敲除曲妥珠单抗的核心岩藻糖、无岩藻糖修饰曲妥珠单抗的临床优势以及提高其ADCC效应的其他Fc段改造方法。     

曲妥珠单抗修饰的阿霉素免疫脂质体的制备及体外性质研究

目的:制备表面键合曲妥珠单抗(trastuzumab,TMAB)的阿霉素免疫脂质(Doxorubicin-loadedimmunoliposome,DOX-IML),并对其体外性质进行研究。方法:将磷脂酰胆碱、胆固醇、阿霉素、DSPE-MPEG2000以一定比例混合,采用薄膜超声分散法制备阿霉素脂质体,将聚乙二醇衍生物(1,2-Distearoyl-sn-glycero-3-phosphoethanolamine-N-[succinimidyl(polyethylene glycol)-3400]、DSPE-PEG3400-NHS)连接到TMAB;再与阿霉素脂质体连接得到DOX-IML。研究不同浓度的TMAB对DOX-IML入胞能力及细胞毒性的影响;测定免疫脂质体的包封率、载药率、粒径、电荷及稳定性等性质;动态透析法模拟体外释药特性,激光共聚焦观察免疫脂质体对AU565细胞抗体介导的入胞作用;MTT法研究DOX-IML抑制肿瘤细胞的生长。结果:成功制备了表面键合TMAB的阿霉素免疫脂质体,配体载入率分别是53%、75.5%、84%;每毫克DOX-IML中抗体的含量分别是37、83、108μg·mg-1;阿霉素的包封率为76.85%、载药量为8.03%;粒径131.8nm;表面电荷-27mV。抗体含量83μg·mg-1的DOX-IML组的细胞存活率最低,细胞内荧光强度最高,且该免疫脂质体稳定性良好,具有一定缓释作用。DOX-IML具有较强的特异性靶向作用,其入胞能力和细胞毒性均高于阿霉素脂质体。结论:DOX-IML具有较强的特异性靶向作用,其入胞能力和细胞毒性均高于阿霉素脂质体,抗体含量适中时其入胞能力和细胞毒性最强。     

曲妥珠单抗在HER-2阳性乳腺癌治疗中的研究进展

乳腺癌是女性最常见的恶性肿瘤之一,中国女性乳腺癌发病率逐年上升。人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)在近三分之一的乳腺癌患者中呈现基因扩增或受体蛋白高表达。HER-2阳性的乳腺癌患者预后差,术后复发风险高、生存期短。曲妥珠单抗是人表皮生长因子受体-2的特异性抑制剂[1],在HER-2阳性乳腺癌患者的治疗中得到了广泛的应用,并且曲妥珠单抗分子靶向治疗相比于传统的化疗,具有特异性较强,毒副反应相对较小等优点。它改变了HER-2阳性乳腺癌患者的自然疾病进程,延长了患者的生存时间。本文将从四个方面对曲妥珠单抗在HER-2阳性乳腺癌患者治疗中的研究、应用及进展进行综述。     

曲妥珠单抗联合SOX方案治疗HER-2阳性晚期胃癌的临床疗效观察

目的:探讨曲妥珠单抗联合替吉奥和奥沙利铂(SOX方案)治疗人类表皮生长因子受体-2(HER-2)阳性晚期胃癌的临床疗效。方法:选择2014年2月到2016年2月在我院收治的48例HER-2阳性晚期胃癌患者,随机分为实验组和对照组,各24例。对照组患者给予SOX化疗方案,实验组患者给予曲妥珠单抗联合SOX化疗方案,两组患者均给予治疗3个疗程。评价并比较两组患者临床疗效。比较两组患者治疗后不良反应发生情况。检测并比较两组患者治疗前后血清糖类抗原125(CA125)、癌胚抗原(CEA)及组织多肽特异性抗原(TPS)水平。结果:实验组患者的有效率(RR)为58.33%、疾病控制率(DCR)为87.50%,均明显高于对照组患者的29.17%和45.83%,差异具有统计学意义(P0.05)。治疗后两组患者血清CA125、CEA及TPS水平均明显低于治疗前,且实验组患者上述各指标均明显低于对照组,差异具有统计学意义(P0.05)。两组患者不良反应发生率比较差异均无统计学意义(P0.05)。结论:曲妥珠单抗联合SOX方案治疗HER-2阳性晚期胃癌患者临床疗效显著,能够明显降低血清CA125、CEA及TPS水平,不良反应发生率低,值得在临床上推广应用。     

IQGAP1 protein binds human epidermal growth factor receptor 2 (HER2) and modulates trastuzumab resistance

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 20-25% of breast cancers. Increased HER2 expression is an adverse prognostic factor and correlates with decreased patient survival. HER2-positive (HER2(+)) breast cancer is treated with trastuzumab. Unfortunately, some patients are intrinsically refractory to therapy, and many who do respond initially become resistant within 1 year. Understanding the molecular mechanisms underlying HER2 signaling and trastuzumab resistance is essential to reduce breast cancer mortality. IQGAP1 is a ubiquitously expressed scaffold protein that contains multiple protein interaction domains. By regulating its binding partners IQGAP1 integrates signaling pathways, several of which contribute to breast tumorigenesis. We show here that IQGAP1 is overexpressed in HER2(+) breast cancer tissue and binds directly to HER2. Knockdown of IQGAP1 decreases HER2 expression, phosphorylation, signaling, and HER2-stimulated cell proliferation, effects that are all reversed by reconstituting cells with IQGAP1. Reducing IQGAP1 up-regulates p27, and blocking this increase attenuates the growth inhibitory effects of IQGAP1 knockdown. Importantly, IQGAP1 is overexpressed in trastuzumab-resistant breast epithelial cells, and reducing IQGAP1 both augments the inhibitory effects of trastuzumab and restores trastuzumab sensitivity to trastuzumab-resistant SkBR3 cells. These data suggest that inhibiting IQGAP1 function may represent a rational strategy for treating HER2(+) breast carcinoma.     

The ErbB2-targeting antibody trastuzumab and the small-molecule SRC inhibitor saracatinib synergistically inhibit ErbB2-overexpressing gastric cancer

The anti-ErbB2 antibody trastuzumab has shown significant clinical benefits in ErbB2-overexpressing breast and gastric cancer, but resistance to the drug is common. Here, we investigated the antitumor activity of the combination of trastuzumab and the SRC inhibitor saracatinib in ErbB2-overexpressing trastuzumab-resistant gastric cancer. The ErbB2-overexpressing human gastric cancer cell line NCI-N87 was treated with trastuzumab to obtain the trastuzumab-resistant cell line NCI-N87R. The NCI-N87R cell line showed a marked increase in SRC activity and ErbB signaling compared with the NCI-N87 cell line. Our data demonstrated that trastuzumab plus saracatinib was much more potent than either agent alone in reducing the phosphorylation of ErbB3 and AKT in both NCI-N87 and NCI-N87R gastric cancer cell lines. Trastuzumab and saracatinib synergistically inhibited the in vitro growth of NCI-N87 and NCI-N87R cell lines. Further data showed that combination therapy of trastuzumab with saracatinib resulted in a significant benefit over either agent alone in both NCI-N87 and NCI-N87R xenograft models, suggesting its potential use for treating ErbB2-overexpressing gastric cancer.     

Phosphorylated ribosomal S6 (p-rpS6) as a post-treatment indicator of HER2 signalling targeted drug resistance

Abstract

Objective: To identify clinically relevant predictive biomarkers of trastuzumab resistance.

Material and methods: MTT, FACS assays, immunoblotting and immunocytochemistry were used to phenotypically characterize drug responses of two cell models BT474R and SKBR3R. Student's t-test and Spearman's correlation were applied for statistic analysis.

Results: The activity of a downstream effector of the HER2 pathway phosphorylated ribosomal protein S6 (p-rpS6), was suppressed by trastuzumab in the parental cell lines yet remained unchanged in the resistant cells following treatment. The level of p-rpS6 was inversely correlated to the drug induced growth inhibition of trastuzumab-resistant cells when they are treated with selected HER2 targeting drugs.

Conclusion: p-rpS6 is a robust post-treatment indicator of HER2 pathway-targeted therapy resistance.     

Breast tumor cells isolated from in vitro resistance to trastuzumab remain sensitive to trastuzumab anti-tumor effects in vivo and to ADCC killing

An understanding of model systems of trastuzumab (Herceptin) resistance is of great importance since the humanized monoclonal antibody is now used as first line therapy with paclitaxel in patients with metastatic Her2 overexpressing breast cancer, and the majority of their tumors has innate resistance or develops acquired resistance to the treatment. Previously, we selected trastuzumab-resistant clonal cell lines in vitro from trastuzumab-sensitive parental BT-474 cells and showed that cloned trastuzumab-resistant cell lines maintain similar levels of the extracellular Her2 receptor, bind trastuzumab as efficiently as the parental cells, but continue to grow in the presence of trastuzumab and display cell cycle profiles and growth rates comparable to parental cells grown in the absence of trastuzumab (Kute et al. in Cytometry A 57:86–93, 2004). We now show that trastuzumab-resistant and trastuzumab-sensitive cells both surprisingly display trastuzumab-mediated growth inhibition in athymic nude mice. This demonstrates that resistance developed in vitro is not predictive of resistance in vivo. The observation that in vitro resistant cells are sensitive to trastuzumab in vivo could be explained by antibody dependant cellular cytotoxicity (ADCC). Therefore, both parental and trastuzumab-resistant cells were assayed for ADCC in real time on electroplates with and without trastuzumab in the presence of a natural killer cell line (NK-92), and granulocyte or mononuclear cellular fractions isolated from human peripheral blood. Mononuclear cells and NK-92 cells were more effective in killing both parental and trastuzumab-resistant cells in the presence of trastuzumab. Both trastuzumab-resistant cells and trastuzumab-sensitive cells showed similar susceptibility to ADCC despite displaying divergent growth responses to trastuzumab. The granulocyte fraction was able to kill these cells with equal efficacy in the presence or absence of trastuzumab. These results support a model of trastuzumab tumor cell killing in vivo mediated primarily by ADCC from the mononuclear fraction of innate immune cells and suggest that in the clinical setting not only should changes in signaling transduction pathways be studied in acquired tumor resistance to trastuzumab, but also mechanisms by which tumors impede immune function should be evaluated.     

Potent anti-proliferative effects of metformin on trastuzumab-resistant breast cancer cells via inhibition of erbB2/IGF-1 receptor interactions

We have shown that erbB2 altered breast cancer cells are less sensitive to the anti-proliferative effects of metformin than triple negative cells, and have described the differences of molecular mechanisms of metformin action by tumor subtypes. We hypothesized that metformin may be more effective against trastuzumab-resistant erbB2-overexpressing breast cancer cells because it targets the critical signaling pathways that are altered with resistance. BT474, SKBR3 and derived trastuzumab-resistant sublines BT474-HR20 (HR20) and SKBR3-pool2 (pool2) were used to test this hypothesis. Metformin treatment resulted in significantly more inhibition of proliferation and clonogenicity in resistant sublines. It decreased erbB2/insulin-like growth factor-1 receptor (IGF-1R) complexes (present only in the resistant sublines) without altering erbB2 expression, and reduced the expression and activity of erbB3 and IGF-1R in the trastuzumab-resistant but not parental cells. Trastuzumab-resistant sublines were resistant to rapamycin induced changes in mTOR activity and cell growth. In contrast, both BT474 and HR20 cells were highly sensitive to inhibitors of Src (Dasatinib) and PI-3K (LY294002). The pool2 cells showed higher sensitivity than SKBR3 cells to LY294002, but not Dasatinib. On the basis of these data, metformin appears to be significantly more effective against trastuzumab-resistant as compared to sensitive breast cancer cells. Metformin disrupts erbB2/IGF-1R complexes, erbB3 and IGF-1R expression and activity, as well as Src kinase and/or PI-3K/Akt signaling. This action appears to be independent of mTOR signaling. Our findings provide a rationale to study the effects of metformin on patients with erbB2 positive tumors treated with trastuzumab, with or without resistance.     

Artemin,a Member of the Glial Cell Line-derived Neurotrophic Factor Family of Ligands,Is HER2-regulated and Mediates Acquired Trastuzumab Resistance by Promoting Cancer Stem Cell-like Behavior in Mammary Carcinoma Cells

Previous studies have demonstrated that Artemin (ARTN) functions as a cancer stem cell (CSC) and metastatic factor in mammary carcinoma. Herein, we report that ARTN mediates acquired resistance to trastuzumab in HER2-positive mammary carcinoma cells. Ligands that increase HER2 activity increased ARTN expression in HER2-positive mammary carcinoma cells, whereas trastuzumab inhibited ARTN expression. Forced expression of ARTN decreased the sensitivity of HER2-positive mammary carcinoma cells to trastuzumab both in vitro and in vivo. Conversely, siRNA-mediated depletion of ARTN enhanced trastuzumab efficacy. Cells with acquired resistance to trastuzumab exhibited increased ARTN expression, the depletion of which restored trastuzumab sensitivity. Trastuzumab resistance produced an increased CSC population concomitant with enhanced mammospheric growth. ARTN mediated the enhancement of the CSC population by increased BCL-2 expression, and the CSC population in trastuzumab-resistant cells was abrogated upon inhibition of BCL-2. Hence, we conclude that ARTN is one mediator of acquired resistance to trastuzumab in HER2-positive mammary carcinoma cells.     

BMP9 Inhibits Proliferation and Metastasis of HER2-Positive SK-BR-3 Breast Cancer Cells through ERK1/2 and PI3K/AKT Pathways

Bone morphogenetic protein 9 (BMP9), a member of TGF-β superfamily, is reported to inhibit the growth and migration of prostate cancer, osteosarcoma and triple-negative MDA-MB-231 breast cancer cells. However, little is known about the effect of on the biological behaviors of HER2-positive SK-BR-3 breast cancer cells and the underlying mechanisms. This study aimed to investigate the effects of BMP9 on the proliferation and metastasis of SK-BR-3 cells with BMP9 over-expression or BMP9 down-regulated expression. Results indicated that exogenously expressed BMP9 inhibited the proliferation and metastasis of SK-BR-3 cells while decreased endogenous BMP9 expression in SK-BR-3 cells promoted the proliferation and migration of breast cancer cells in vitro and in vivo. In SK-BR-3 cells with BMP9 over-expression, the phosphorylation of HER2, ERK1/2 and AKT was markedly suppressed and the HER2 expression decreased at both mRNA and protein levels, while opposite results were observed in SK-BR-3 cells with BMP9 knock down. When the phosphorylation of ERK1/2 and PI3K/AKT was inhibited by PD98059 and {"type":"entrez-nucleotide","attrs":{"text":"LY294002","term_id":"1257998346","term_text":"LY294002"}}LY294002, respectively, the decreased proliferation and invasion induced by BMP9 knock down were eliminated. These findings suggest that BMP9 can inhibit the proliferation and metastasis of SK-BR-3 cells via inactivating ERK1/2 and PI3K/AKT signaling pathways. Thus, BMP9 may serve as a useful agent in the treatment of HER-2 positive breast cancer.     

Mycophenolic acid potentiates HER2-overexpressing SKBR3 breast cancer cell line to induce apoptosis: involvement of AKT/FOXO1 and JAK2/STAT3 pathways

Trastuzumab has been successfully used as a first-line therapy specific for HER2-overexressing breast cancer patients. However, despite the effectiveness of trastuzumab, the occurrence of inherent and acquired resistance remains as the main challenge of the therapy. Thus, this has motivated efforts toward finding new therapeutic strategies including combining trastuzumab with other drugs to enhance its therapeutic efficacy. In that line, we investigated the capability of mycophenolic acid (MPA), an inhibitor of de novo guanine nucleotide synthesis with potential anti-cancer activity, on improving the response to trastuzumab among SKBR3 cells as well as trastuzumab resistant SKBR3-TR cells. Our data indicated that irrespective to trastuzumab sensitivity of cells, MPA effectively inhibited cell growth through inducing adipocyte-like cell differentiation as well as blocking cell cycle progression at G₁ phase along with augmentation of p27^kip expression level. Furthermore, combined treatment with trastuzumab and MPA was more potent in cell growth inhibition, cell cycle arrest and apoptosis induction, as evident by flow cytometric analyses and caspase-3 production, in both trastuzumab sensitive and resistant SKBR3 cells. Besides, western blot analysis showed that elevated apoptosis induction in both cell groups was associated with attenuation in phosphorylation of some key elements of HER2 signaling pathway including AKT, ERK, STAT3 and consequently augmentation in FOXO1 expression level in response to combination of trastuzumab and MPA. These data suggest that manipulation of intracellular GTP level by MPA and consequent molecular perturbation in some of the cell survival and pro-apoptotic relevant signaling pathways might provide an alternative clinical strategy for chemosensitization of resistant breast cancer cells to anti- HER2 therapy.     

A novel mouse monoclonal antibody targeting ErbB2 suppresses breast cancer growth

Overexpression of ErbB2 in breast cancer is associated with increased recurrence and worse prognosis. Accumulating evidences suggest that molecular targeted therapy is a promising anticancer strategy. In this study, we produced a novel anti-ErbB2 monoclonal antibody, 6G10, that recognized an epitope distinct from the trastuzumab binding site. 6G10 induced aggregation of BT474 breast cancer cells and inhibited proliferation of various breast cancer cell lines including BT474. A growth inhibition assay showed that 6G10 had EC₅₀ values comparable to trastuzumab, indicating that the drugs have a similar level of potency. Furthermore, intraperitoneal administration of 6G10 completely inhibited the growth of xenografted tumors derived from BT474 and SK-BR-3 cells. These data suggested that 6G10 has great therapeutic potential and could be administered to patients alternatively, or synergistically, with trastuzumab.     

Mechanism of resistance to trastuzumab and molecular sensitization via ADCC activation by exogenous expression of HER2-extracellular domain in human cancer cells

Trastuzumab, a humanized antibody targeting HER2, exhibits remarkable therapeutic efficacy against HER2-positive breast and gastric cancers; however, acquired resistance presents a formidable obstacle to long-term tumor responses in the majority of patients. Here, we show the mechanism of resistance to trastuzumab in HER2-positive human cancer cells and explore the molecular sensitization by exogenous expression of HER2-extracellular domain (ECD) in HER2-negative or trastuzumab-resistant human cancer cells. We found that long-term exposure to trastuzumab induced resistance in HER2-positive cancer cells; HER2 expression was downregulated, and antibody-dependent cellular cytotoxicity (ADCC) activity was impaired. We next examined the hypothesis that trastuzumab-resistant cells could be re-sensitized by the transfer of non-functional HER2-ECD. Exogenous HER2-ECD expression induced by the stable transfection of a plasmid vector or infection with a replication-deficient adenovirus vector had no apparent effect on the signaling pathway, but strongly enhanced ADCC activity in low HER2-expressing or trastuzumab-resistant human cancer cells. Our data indicate that restoration of HER2-ECD expression sensitizes HER2-negative or HER2-downregulated human cancer cells to trastuzumab-mediated ADCC, an outcome that has important implications for the treatment of human cancers.