Effective treatment for pancreatic ductal
adenocarcinoma (PDAC) is an urgent, unmet medical need. Targeting KRAS, the oncogene that is present in >95% of PDAC, is a heavily pursued strategy, but remains unsuccessful in the clinic. Therefore, targeting key effector cascades of KRAS
oncoprotein, particularly the mitogenic RAF-MEK-ERK pathway, represents the next best strategy. However, RAF or
MEK inhibitors have failed to show clinical efficacy in PDAC. Several studies have shown that
cancer cells treated with RAF or
MEK inhibitors adopt multiple mechanisms to reactivate ERK signaling. Therefore, development of ERK-specific inhibitors carries the promise to effectively abrogate this pathway.
Ulixertinib (or BVD-523) is a first-in-class ERK-specific inhibitor that has demonstrated promising antitumor activity in a phase I clinical trial for advanced solid
tumors with NRAS and BRAF mutations, providing a strong rationale to test this inhibitor in PDAC. In this study, we show that
ulixertinib effectively inhibits in vitro growth of multiple PDAC lines and potentiates the cytotoxic effect of
gemcitabine. Moreover, we found that PDAC cells treated with
ulixertinib upregulates the parallel PI3K-AKT pathway through activating the HER/ErbB family
proteins. Concurrent inhibition of PI3K or HER
proteins synergizes with
ulixertinib in suppressing PDAC cell growth in vitro and in vivo Overall, our study provides the preclinical rationale for testing combinations of
ulixertinib with
chemotherapy or PI3K and HER inhibitors in PDAC patients. Mol
Cancer Ther; 17(10); 2144-55. ©2018 AACR.