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The ALK inhibitor ceritinib overcomes crizotinib resistance in non-small cell lung cancer

Li, Nanxin and Lee, Christian and Michellys, Pierre and Kim, Sungjoon and Pferdekamper, Annemarie and Li, Jie and Kasibhatla, Shailaja and Sun, Xiuying and Hua, Su and Mcnamara, Peter and Harris, Jennifer and Friboulet, Luc and Katayama, Ryohei and Gainor, Justin and Crystal, Adam and Awad, Mark and Yanagitani, Noriko and Mahmood, Sidra and Lockerman, Elizabeth and Fujita, Naoya and Nishio, Makoto and Shaw, Alice and Engelman, Jeffery and Sun, Frank (2014) The ALK inhibitor ceritinib overcomes crizotinib resistance in non-small cell lung cancer. Cancer Discovery, 4 (6). pp. 662-673. ISSN 2159-8290

Abstract

Non-small cell lung cancers (NSCLC) harboring anaplastic lymphoma kinase (ALK) gene rearrangements invariably develop resistance to the ALK tyrosine kinase inhibitor (TKI) crizotinib. Herein, we report the first preclinical evaluation of the next-generation ALK TKI, ceritinib (LDK378), in the setting of crizotinib resistance. An interrogation of in vitro and in vivo models of acquired resistance to crizotinib, including cell lines established from biopsies of patients with crizotinib-resistant NSCLC, revealed that ceritinib potently overcomes crizotinib-resistant mutations. In particular, ceritinib effectively inhibits ALK harboring L1196M, G1269A, I1171T, and S1206Y mutations, and a cocrystal structure of ceritinib bound to ALK provides structural bases for this increased potency. However, we observed that ceritinib did not overcome two crizotinib-resistant ALK mutations, G1202R and F1174C, and one of these mutations was identified in 5 of 11 biopsies from patients with acquired resistance to ceritinib. Altogether, our results demonstrate that ceritinib can overcome crizotinib resistance, consistent with clinical data showing marked efficacy of ceritinib in patients with crizotinib-resistant disease. SIGNIFICANCE: The second-generation ALK inhibitor ceritinib can overcome several crizotinibresistant mutations and is potent against several in vitro and in vivo laboratory models of acquired resistance to crizotinib. These findings provide the molecular basis for the marked clinical activity of ceritinib in patients with ALK -positive NSCLC with crizotinib-resistant disease. © 2014 American Association for Cancer Research.

Item Type: Article
Date Deposited: 20 Dec 2017 00:45
Last Modified: 25 Jan 2019 00:46
URI: https://oak.novartis.com/id/eprint/11442

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