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Combined Targeting of Endothelin A Receptor and Epidermal Growth Factor Receptor in Ovarian Cancer Shows Enhanced Antitumor Activity

¹ Molecular Pathology and ² Immunology Laboratories, Regina Elena Cancer Institute and ³ Institute of Molecular Biology and Pathology, National Research Council, Rome, Italy, and ⁴ Endocrinology and Molecular Oncology Department, University of Naples, Federico II, Naples, Italy

Requests for reprints: Anna Bagnato, Molecular Pathology Laboratory, Regina Elena Cancer Institute, Via delle Messi D'Oro 156, 00158 Rome, Italy. Phone: 39-06-52662565; Fax: 39-06-52662600; E-mail: bagnato{at}ifo.it.

Ovarian carcinomas overexpress endothelin A receptors (ET_AR) and epidermal growth factor (EGF) receptor (EGFR). In these cells, endothelin-1 (ET-1) triggers mitogenic and invasive signaling pathways that are in part mediated by EGFR transactivation. Combined targeting of ET_AR, by the specific ET_AR antagonist ZD4054, and of EGFR by the EGFR inhibitor gefitinib (IRESSA), may offer improvements in ovarian carcinoma treatment. In HEY and OVCA 433 ovarian carcinoma cells, ET-1 or EGF induced rapid activation of EGFR, p42/44 mitogen-activated protein kinase (MAPK), and AKT. ZD4054 was able to reduce the ET-1–induced EGFR transactivation. Gefitinib significantly inhibited EGF- and ET-1–induced EGFR phosphorylation, but incompletely reduced the ET-1–induced activation of downstream targets. ZD4054 plus gefitinib resulted in a greater inhibition of EGFR, MAPK, and AKT phosphorylation, indicating the critical role of these interconnected signaling proteins. ZD4054 effectively inhibited cell proliferation, invasiveness, and vascular endothelial growth factor (VEGF) secretion. Concomitantly, ZD4054 enhanced apoptosis and E-cadherin promoter activity and expression. In both cell lines, the drug combination resulted in a significant decrease in cell proliferation (65%), invasion (52%), and VEGF production (50%), accompanied by a 2-fold increase in apoptosis. The coadministration of ZD4054 enhanced the efficacy of gefitinib leading to partial (82%) or complete tumor regression on HEY ovarian carcinoma xenografts. Antitumor effects were paralleled by biochemical and immunohistologic evidence of decreased vascularization, Ki-67, matrix metalloproteinase-2 (MMP-2), VEGF, MAPK and EGFR, and enhanced E-cadherin expression. The cross-signaling between the EGFR/ET_AR pathways provides a rationale to combine EGFR inhibitors with ET_AR antagonists, identifying new effective therapeutic opportunities for ovarian cancer. [Cancer Res 2007;67(13):6351–9]