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Experimental Therapeutics, Molecular Targets and Chemical Biology |
Departments of 1 Pharmacology and 2 Otolaryngology, University of Pittsburgh and 3 Lung and Thoracic Malignancy Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
Requests for reprints: Jill M. Siegfried, Hillman Cancer Center, University of Pittsburgh Cancer Institute Research Pavilion, Suite 2.18, 5117 Center Avenue, Pittsburgh, PA 15213-1863. Phone: 412-623-7769; Fax: 412-623-7768; E-mail: siegfriedjm{at}upmc.edu.
Identifying new effective therapeutic treatments for lung cancer is critical to improving overall patient survival. We have targeted both the estrogen receptor (ER) and the epidermal growth factor receptor (EGFR) pathways using an ER antagonist, fulvestrant ("Faslodex"), and the selective EGFR tyrosine kinase inhibitor, gefitinib ("Iressa"), in non–small cell lung cancer (NSCLC) cells. Rapid activation of phospho-EGFR and phospho-p44/p42 mitogen-activated protein kinase by estrogen was observed, indicating nonnuclear ER transactivation of EGFR. Additionally, EGFR protein expression was down-regulated in response to estrogen and up-regulated in response to fulvestrant in vitro, suggesting that the EGFR pathway is activated when estrogen is depleted in NSCLC cells. Cell growth and apoptosis were examined in several NSCLC lines that express varying amounts of ERß, EGFR, and Neu but no full-length ER
. One cell line contained an EGFR mutation. Cells were exposed to 10 nmol/L estrogen and 10 ng/mL EGF and either 1 µmol/L fulvestrant or 1 µmol/L gefitinib alone or in combination. In all cell lines, the drug combination decreased cell proliferation up to 90% and increased apoptosis 2-fold. The relative responses to gefitinib and fulvestrant were similar regardless of ER and EGFR expression and mutation status. In an in vivo lung tumor xenograft model, the drug combination decreased tumor volume in severe combined immunodeficient mice by 
60% compared with 49% and 32% for gefitinib and fulvestrant treatment alone, respectively. Antitumor effects of the combination therapy were accompanied by biochemical and histologic evidence of increased apoptosis, decreased phospho-p44/p42 mitogen-activated protein kinase expression, and increased Ki-67 expression compared with individual treatment. These studies provide evidence of a functional interaction between the ER and the EGFR pathways in NSCLC.
Key Words: estrogen receptor • epidermal growth factor receptor • gefitinib • fulvestrant • NSCLC
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