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Expression of the K303R Estrogen Receptor- Breast Cancer Mutation Induces Resistance to an Aromatase Inhibitor via Addiction to the PI3K/Akt Kinase Pathway

¹ Breast Center and ² Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas; ³ Department of Pharmaco-Biology, ⁴ Centro Sanitario, and ⁵ Department of Cellular Biology, University of Calabria, Arcavacata di Rende, Cosenza, Italy

Requests for reprints: Suzanne A.W. Fuqua, Breast Center, Baylor College of Medicine, BCM 600, One Baylor Plaza, Houston, TX 77030. Phone: 713-798-1672; Fax: 713-798-1673; E-mail: sfuqua{at}bcm.edu.

Key Words: Estrogen receptor • Breast cancer • Aromatase inhibitors • Hormone resistance • PI3K/Akt kinase pathway

Aromatase inhibitors (AI) are rapidly becoming the first choice for hormonal treatment of estrogen receptor- (ER)–positive breast cancer in postmenopausal women. However, de novo and acquired resistance frequently occurs. We have previously identified a lysine to arginine transition at residue 303 (K303R) in ER in premalignant breast lesions and invasive breast cancers, which confers estrogen hypersensitivity and resistance to tamoxifen treatment. Thus, we questioned whether resistance to AIs could arise in breast cancer cells expressing the ER mutation. As preclinical models to directly test this possibility, we generated K303R-overexpressing MCF-7 cells stably transfected with an aromatase expression vector. Cells were stimulated with the aromatase substrate, androstenedione, with or without the AI anastrozole (Ana). We found that Ana decreased androstenedione-stimulated growth of wild-type cells, whereas K303R-expressing cells were resistant to the inhibitory effect of Ana on growth. We propose that a mechanism of resistance involves an increased binding between the mutant receptor and the p85 regulatory subunit of phosphatidylinositol-3-OH kinase (PI3K), leading to increased PI3K activity and activation of protein kinase B/Akt survival pathways. Inhibition of the selective "addiction" to the PI3K/Akt pathway reversed AI resistance associated with expression of the mutant receptor. Our findings suggest that the K303R ER mutation might be a new predictive marker of response to AIs in mutation-positive breast tumors, and that targeting the PI3K/Akt pathway may be a useful strategy for treating patients with tumors resistant to hormone therapy. [Cancer Res 2009;69(11):4724–32]