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Open Access Highly Accessed Research article

The combination of gefitinib and RAD001 inhibits growth of HER2 overexpressing breast cancer cells and tumors irrespective of trastuzumab sensitivity

Wieslawa H Dragowska1*, Sherry A Weppler1, Mohammed A Qadir1, Ling Yan Wong1, Yannick Franssen1, Jennifer HE Baker2, Anita I Kapanen1, Guido JJ Kierkels1, Dana Masin1, Andrew I Minchinton23, Karen A Gelmon4 and Marcel B Bally1356

Author Affiliations

1 Experimental Therapeutics, British Columbia Cancer Agency, 675 West 10th Ave, Vancouver, BC, V5Z 1L3, Canada

2 Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada

3 Faculty of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

4 Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada

5 Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

6 Center for Drug Research and Development; Vancouver, BC, Canada

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BMC Cancer 2011, 11:420  doi:10.1186/1471-2407-11-420

Published: 1 October 2011

Abstract

Background

HER2-positive breast cancers exhibit high rates of innate and acquired resistance to trastuzumab (TZ), a HER2-directed antibody used as a first line treatment for this disease. TZ resistance may in part be mediated by frequent co-expression of EGFR and by sustained activation of the mammalian target of rapamycin (mTOR) pathway. Here, we assessed feasibility of combining the EGFR inhibitor gefitinib and the mTOR inhibitor everolimus (RAD001) for treating HER2 overexpressing breast cancers with different sensitivity to TZ.

Methods

The gefitinib and RAD001 combination was broadly evaluated in TZ sensitive (SKBR3 and MCF7-HER2) and TZ resistant (JIMT-1) breast cancer models. The effects on cell growth were measured in cell based assays using the fixed molar ratio design and the median effect principle. In vivo studies were performed in Rag2M mice bearing established tumors. Analysis of cell cycle, changes in targeted signaling pathways and tumor characteristics were conducted to assess gefitinib and RAD001 interactions.

Results

The gefitinib and RAD001 combination inhibited cell growth in vitro in a synergistic fashion as defined by the Chou and Talalay median effect principle and increased tumor xenograft growth delay. The improvement in therapeutic efficacy by the combination was associated in vitro with cell line dependent increases in cytotoxicity and cytostasis while treatment in vivo promoted cytostasis. The most striking and consistent therapeutic effect of the combination was increased inhibition of the mTOR pathway (in vitro and in vivo) and EGFR signaling in vivo relative to the single drugs.

Conclusions

The gefitinib and RAD001 combination provides effective control over growth of HER2 overexpressing cells and tumors irrespective of the TZ sensitivity status.