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Abstract 1873: Drivers of secondary resistance to anti-EGFR therapy in metastatic colorectal cancer

Secondary Resistance (SR) evolves in virtually all metastatic colorectal cancers (mCRC) treated with anti-EGFR targeting drugs such as Cetuximab (Cmab). Yet, SR patient-derived xenograft (pdx) models are largely lacking. Here, we established eight SR pdx models through chronic Cmab treatment of drug-sensitive mCRC pdx. All pdx models were initially wild-type for KRAS, NRAS, PI3K and BRAF, as required for Cmab treatment. Post SR establishment, two models showed KRAS mutations and were excluded from further studies. Whole exome sequencing of the remaining six SR pdx models did not reveal any known driver mutations which could confer SR. However, global gene expression analyses identified widespread transcriptional reprograming with many genes able to activate KRAS and/or PI3K signaling pathways. Among the highly dysregulated genes, fibroblast growth factors FGF13, FGF19, FGF20, and insulin-like growth factor IGF2 stood out as potential drivers of SR through upregulation of RTK signaling. Functional molecular analyses of these factors were performed using lentiviral vector mediating gene transduction. Cell viability, proliferation assays and western blot (WB) analyses were applied to assess the molecular functionality of FGFs and IGF2-ligands in vitro. Finally, transgenic cell lines were injected into nude mice to test their therapeutic response towards Cmab treatment following upregulation or downregulation of the chosen candidates. Stable lentiviral overexpression of FGF13 and IGF2 in drug-sensitive cell lines and pdx models triggered SR both in vitro and in vivo. WB analyses showed that FGF13 and IGF2 overexpression induced phosphorylation of pAKT, pS6, and pERK. Conversely, knockdown of IGF2 in a cell line with high endogenous IGF2 expression improved Cmab sensitivity. Lastly, when subjecting a Cmab SR pdx model with high endogenous overexpression of FGF13 and FGF19 to a Pan-FGF inhibitor (LY2874455) in combination with Cmab, we observed a conversion of the SR into partial response. Taken together, these results support a role of IGF2 and FGFs as candidate proteins conferring SR in an autocrine fashion in the setting of KRAS wild-type mCRC under chronic anti-EGFR treatment. Importantly, these results also suggest that potential combination therapies of Cmab and an IGF2 or FGF inhibitor could prevent establishment of SR through these pathways and offer new treatment opportunities for patients with SR mCRC. Citation Format: Soha Hussein Noseir, Stephan Hahn, Abdelouahid Maghnouj, Swetlana Ladigan. Drivers of secondary resistance to anti-EGFR therapy in metastatic colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1873.