1188P - Poly-therapy with EGFR, STAT3 and Src-YAP1 signaling pathway inhibition; A breakthrough for EGFR mutant NSCLC

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Anticancer Agents
Non-Small Cell Lung Cancer
Biological Therapy
Presenter Niki Karachaliou
Citation Annals of Oncology (2016) 27 (6): 411-415. 10.1093/annonc/mdw382
Authors N. Karachaliou1, I. Chaib2, X. Cai3, X. Li4, A.F. Cardona5, G. López-Vivanco6, A. Vergnenegre7, J.M. Sanchez Torres8, M. Provencio9, F. de Marinis10, E. Carecereny11, N. Reguart12, R. García Campelo13, S. Viteri1, M.A. Molina Vila14, C. Zhou4, P. Cao3, P. Ma15, T. Bivona16, R. Rosell17
  • 1Medical Oncology Service, Instituto Oncológico Dr Rosell (IOR), Hospital Universitario Quirón-Dexeus, 08028 - Barcelona/ES
  • 2Laboratory Of Cellular And Molecular Biology, Institut d'Investigació en Ciències Germans Trias i Pujol, 08916 - Badalona/ES
  • 3Laboratory Of Cellular And Molecular Biology, Academy of Traditional Chinese Medicine, 210028 - Nanjing/CN
  • 4Lung Cancer Oncology & Immunology, Tongji Hospital of Tongji University, 200433 - Shanghai/CN
  • 5Medical Oncology, Clinica del Country, 318 - Bogota/CO
  • 6Medical Oncology, Hospital de Cruces, 48903 - Barakaldo/ES
  • 7Service De L'uotc, CHU Limoges - Hopital Dupuytren, 87042 - Limoges/FR
  • 8Medical Oncology Service, Hospital Universitario de La Princesa, 28006 - Madrid/ES
  • 9Medical Oncology, Hospital Universitario Puerta de Hierro Majadahond, 28222 - Majadahonda/ES
  • 101 Unità Operativa Di Pneumologia Oncologica, Istituto Europeo di Oncologia, 20141 - Milano/IT
  • 11Medical Oncology, Catalan Institute of Oncology (ICO Badalona), Hospital Germans Trias i Pujol, 08916 - Badalona/ES
  • 12Medical Oncology, Hospital Clinic y Provincial de Barcelona, 08036 - Barcelona/ES
  • 13Medical Oncology, Hospital Universitario a Coruna - a Corunac, 15006 - A Coruna/ES
  • 14Laboratory Of Cellular And Molecular Biology, Pangaea Biotech SL, IOR Quirón-Dexeus University Institute, 08028 - Barcelona/ES
  • 15Solid Tumor Oncology, West Virginia University Mary Babb Randolph Cancer Center, 26506 - Morgantown/US
  • 16Hematology And Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, 94115 - San Francisco/US
  • 17Translational Research Unit, Laboratory Of Molecular Biology, Catalan Institute of Oncology (ICO Badalona), Hospital Germans Trias i Pujol, 08916 - Badalona/ES



Since the discovery of epidermal growth factor receptor (EGFR) mutations in 2004 as a driver alteration in non-small-cell lung cancer (NSCLC), mono-therapy with EGFR tyrosine kinase inhibitors (TKIs) is the conventional therapy. Growing evidence demonstrates that single EGFR TKI hyper-activates signal transducer and activator of transcription 3 (STAT3) almost immediately after starting treatment.


We conducted clinical and preclinical studies of key components of signaling pathways limiting EGFR TKI efficacy in EGFR mutant NSCLC.


Gefitinib suppressed EGFR, ERK1/2 and AKT phosphorylation but increased STAT3 phosphorylation on the critical tyrosine residue 705 (pSTAT3-Tyr705) in a time and dose-dependent manner in PC9 cells. Gefitinib with TPCA-1 (STAT3 inhibitor) abolished pSTAT3-Tyr705. In addition to STAT3 activation, co-activation of Src-YES-associated protein 1 (YAP1) was also unexpectedly observed in our study. Gefitinib with TPCA-1 blocked STAT3, but not the YAP1 phosphorylation on tyrosine residue 357 by Src family kinases (SFKs). The triple combination of gefitinib, TPCA-1 and AZD0530 (SFK inhibitor) ablated both STAT3 and YAP1 phosphorylation and had greater effect than gefitinib alone or double combinations in vitro and in vivo.

High levels of STAT3 or YAP1 mRNA expression were associated with worse outcome to EGFR TKI in two independent cohorts of EGFR-mutant NSCLC patients. In the initial cohort of 64 patients, progression-free survival (PFS) was shorter among the patients with high STAT3 than among those with low STAT3 (hazard ratio [HR] for disease progression, 3.02; 95% confidence interval [CI], 1.54-5.93; P = 0.0013). PFS was shorter among the patients with high YAP1 than among those with low YAP1 (HR for disease progression, 2.57; 95%CI, 1.30-5.09; P = 0.0067). The results were similar in the validation cohort of 55 patients.


Co-targeting STAT3 and Src-YAP1-NOTCH signaling pathways could be a feasible solution that would have a major impact in prolonging cancer free survival in EGFR mutant NSCLC patients.

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This work was supported by grants from the La Caixa Foundation and Red Tematica de Investigacion Cooperativa en Cancer (RTICC; grant RD12/0036/ 0072), the National Natural Science Foundation of China (No. 81573680), and the Jiangsu Province Funds for Distinguished Young Scientists (No. BK20140049).


All authors have declared no conflicts of interest.