Preconditioning with INC280 and LDK378 drugs sensitizes MGMT-unmethylated glioblastoma to temozolomide: Pre-clinical assessment

J Neurol Sci. 2020 Nov 15:418:117102. doi: 10.1016/j.jns.2020.117102. Epub 2020 Aug 21.


Temozolomide (TMZ) therapy is the standard of care for patients with glioblastoma (GBM). Clinical studies have shown that elevated levels of DNA repair protein O (6)-methylguanine-DNA methyltransferase (MGMT) or deficiency/defect of DNA mismatch repair (MMR) genes is associated with TMZ resistance in some, but not all, GBM tumors. Another reason for GBM treatment failure is signal redundancy due to coactivation of several functionally linked receptor tyrosine kinases (RTKs), including anaplastic lymphoma kinase (ALK) and c-Met (hepatocyte growth factor receptor). As such, these tyrosine kinases serve as potential targets for GBM therapy. Thus, we tested two novel drugs: INC280 (Capmatinib: a highly selective c-Met receptor tyrosine kinase-RTK inhibitor) and LDK378 (Ceritinib: a highly selective anaplastic lymphoma kinase-ALK inhibitor), aiming to overcome TMZ resistance in MGMT-unmethylated GBM cells in in vitro cell culture models. Treatments were examined using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, caspase-3 assay and western blot analysis. Results obtained from our experiments demonstrated that preconditioning with INC280 and LDK378 drugs exhibit increased MMR protein expression, specifically MMR protein MLH1 (MutL Homolog 1) and MSH6 (MutS Homolog 6) and sensitized TMZ in MGMT-unmethylated GBM cells via suppression of ALK and c-Met expression. INC280 and LDK378 plus TMZ also induced apoptosis by modulating downstream signaling of PI3K/AKT/STAT3. Taken together, this data indicates that co-inhibition of ALK and c-MET can enhance growth inhibitory effects in MGMT-unmethylated cells and enhance TMZ sensitivity in-vitro, suggesting c-Met inhibitors combined with ALK-targeting provide a therapeutic benefit in MGMT-unmethylated GBM patients.

Keywords: ALK; GBM; MGMT; MMR; Temozolomide; c-Met.

MeSH terms

  • Antineoplastic Agents, Alkylating / pharmacology
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Benzamides
  • Brain Neoplasms* / drug therapy
  • Brain Neoplasms* / genetics
  • Cell Line, Tumor
  • DNA Modification Methylases / genetics
  • DNA Repair Enzymes / genetics
  • Drug Resistance, Neoplasm / genetics
  • Glioblastoma* / drug therapy
  • Glioblastoma* / genetics
  • Humans
  • Imidazoles
  • Pharmaceutical Preparations*
  • Phosphatidylinositol 3-Kinases
  • Pyrimidines
  • Sulfones
  • Temozolomide / pharmacology
  • Temozolomide / therapeutic use
  • Triazines
  • Tumor Suppressor Proteins / genetics


  • Antineoplastic Agents, Alkylating
  • Benzamides
  • Imidazoles
  • Pharmaceutical Preparations
  • Pyrimidines
  • Sulfones
  • Triazines
  • Tumor Suppressor Proteins
  • DNA Modification Methylases
  • MGMT protein, human
  • DNA Repair Enzymes
  • ceritinib
  • capmatinib
  • Temozolomide