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The brain microenvironment mediates resistance in luminal breast cancer to PI3K inhibition through HER3 activation

David P Kodack, Vasileios Askoxylakis, Gino B Ferraro, Qing Sheng, Mark Badeaux, Shom Goel, Xiaolong Qi, Ram Shankaraiah, Z Alexander Cao, Rakesh R Ramjiawan, Divya Bezwada, Bhushankumar Patel, Yongchul Song, Carlotta Costa, Kamila Naxerova, Christina S.F. Wong, Jonas Kloepper, Rita Das, Angela Tam, Jantima Tanboon, Dan G Duda, Ryan Miller, Marni B Siegel, Carey K Anders, Melinda Sanders, Monica V Estrada, Robert Schlege, Carlos L Arteaga, Elena Brachtel, Alan Huang, Dai Fukumura, Jeffrey A Engelman, Rakesh K Jain
Science Translational Medicine2017
Although targeted therapies are often effective systemically, they fail to adequately control brain metastases. In preclinical models of breast cancer that faithfully recapitulate the disparate clinical responses in these microenvironments, we observed that brain metastases evade phosphatidylinositide 3-kinase (PI3K) inhibition despite drug accumulation in the brain lesions. In comparison to extracranial disease, we observed increased HER3 expression and phosphorylation in brain lesions. HER3 blockade overcame the resistance of HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases to PI3K inhibitors, resulting in marked tumor growth delay and improvement in mouse survival. These data provide a mechanistic basis for therapeutic resistance in the brain microenvironment and identify translatable treatment strategies for HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases.
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