NRAS Status Determines Sensitivity to SHP2 Inhibitor Combination Therapies Targeting the RAS-MAPK Pathway in Neuroblastoma

Cancer Res. 2020 Aug 15;80(16):3413-3423. doi: 10.1158/0008-5472.CAN-19-3822. Epub 2020 Jun 25.

Abstract

Survival for high-risk neuroblastoma remains poor and treatment for relapsed disease rarely leads to long-term cures. Large sequencing studies of neuroblastoma tumors from diagnosis have not identified common targetable driver mutations other than the 10% of tumors that harbor mutations in the anaplastic lymphoma kinase (ALK) gene. However, at neuroblastoma recurrence, more frequent mutations in genes in the RAS-MAPK pathway have been detected. The PTPN11-encoded tyrosine phosphatase SHP2 is an activator of the RAS pathway, and we and others have shown that pharmacologic inhibition of SHP2 suppresses the growth of various tumor types harboring KRAS mutations such as pancreatic and lung cancers. Here we report inhibition of growth and downstream RAS-MAPK signaling in neuroblastoma cells in response to treatment with the SHP2 inhibitors SHP099, II-B08, and RMC-4550. However, neuroblastoma cell lines harboring endogenous NRAS Q61K mutation (which is commonly detected at relapse) or isogenic neuroblastoma cells engineered to overexpress NRASQ61K were distinctly resistant to SHP2 inhibitors. Combinations of SHP2 inhibitors with other RAS pathway inhibitors such as trametinib, vemurafenib, and ulixertinib were synergistic and reversed resistance to SHP2 inhibition in neuroblastoma in vitro and in vivo. These results suggest for the first time that combination therapies targeting SHP2 and other components of the RAS-MAPK pathway may be effective against conventional therapy-resistant relapsed neuroblastoma, including those that have acquired NRAS mutations. SIGNIFICANCE: These findings suggest that conventional therapy-resistant, relapsed neuroblastoma may be effectively treated via combined inhibition of SHP2 and MEK or ERK of the RAS-MAPK pathway.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aminopyridines / therapeutic use
  • Animals
  • Antineoplastic Agents / therapeutic use
  • Cell Line, Tumor
  • Drug Resistance, Neoplasm / genetics
  • Drug Synergism
  • Genes, ras*
  • Heterografts
  • Humans
  • Indoles / therapeutic use
  • MAP Kinase Signaling System / drug effects
  • Male
  • Mice, Inbred NOD
  • Mice, SCID
  • Mitogen-Activated Protein Kinase Kinases / antagonists & inhibitors
  • Mitogen-Activated Protein Kinase Kinases / genetics*
  • Mutation
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / genetics
  • Neoplasm Recurrence, Local / pathology
  • Neuroblastoma / drug therapy*
  • Neuroblastoma / genetics
  • Neuroblastoma / pathology
  • Piperidines / therapeutic use
  • Protein Tyrosine Phosphatase, Non-Receptor Type 11 / antagonists & inhibitors*
  • Protein Tyrosine Phosphatase, Non-Receptor Type 11 / genetics
  • Pyridones / therapeutic use
  • Pyrimidines / therapeutic use
  • Pyrimidinones / therapeutic use
  • Pyrroles / therapeutic use
  • Triazoles / therapeutic use
  • Vemurafenib / therapeutic use

Substances

  • 3-(1-(3-(biphenyl-4-ylamino)-3-oxopropyl)-1H-1,2,3-triazol-4-yl)-6-hydroxy-1-methyl-2-phenyl-1H-indole-5-carboxylic acid
  • Aminopyridines
  • Antineoplastic Agents
  • Indoles
  • Piperidines
  • Pyridones
  • Pyrimidines
  • Pyrimidinones
  • Pyrroles
  • SHP099
  • Triazoles
  • ulixertinib
  • Vemurafenib
  • trametinib
  • Mitogen-Activated Protein Kinase Kinases
  • PTPN11 protein, human
  • Protein Tyrosine Phosphatase, Non-Receptor Type 11