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Significance of thymidylate synthase for resistance to pemetrexed in lung cancer

Pemetrexed (MTA) is a multitargeted antifolate with promising clinical activity in lung cancer. We exposed the small cell lung cancer cell line PC6 to stepwise‐increasing pemetrexed concentrations of 0.4, 1.6, and 4.0 μm, and established three pemetrexed‐resistant lung cancer cell lines: PC6/MTA‐0.4, PC6/MTA‐1.6, and PC6/MTA‐4.0 cells. To investigate the mechanisms of acquired resistance to pemetrexed, we measured the expression levels of the thymidylate synthase (TS), reduced folate carrier (RFC), and folylpoly‐gamma‐glutamate synthetase (FPGS) genes. TS gene expression was significantly increased in PC6/MTA‐1.6 and PC6/MTA‐4.0 cells relative to parental cells in a pemetrexed dose‐dependent manner. In contrast, the levels of RFC gene expression in PC6/MTA‐0.4 cells and FPGS in PC6/MTA‐1.6 cells were significantly decreased, whereas the levels of both genes were restored in PC6/MTA‐4.0 cells. Knockdown of TS expression using siRNA enhanced pemetrexed cytotoxicity in PC6/MTA‐4.0 cells. The expression level of the TS gene was significantly correlated with the concentration of pemetrexed for 50% cell survival (IC50) in 11 non‐small cell lung cancer cell lines. These results suggest that the alteration of molecular pharmacological factors in relation with pemetrexed resistance is dose‐dependent, and that up‐regulation of the expression of the TS gene may have an important role in the acquired resistance to pemetrexed. In addition, TS may be a predictive marker for pemetrexed sensitivity in lung cancer. (Cancer Sci 2009)