Aurora kinase A drives the evolution of resistance to third-generation EGFR inhibitors in lung cancer

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Although targeted therapies often elicit profound initial patient responses, these effects are transient due to residual disease leading to acquired resistance. How tumors transition between drug responsiveness, tolerance and resistance, especially in the absence of preexisting subclones, remains unclear. In epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma cells, we demonstrate that residual disease and acquired resistance in response to EGFR inhibitors requires Aurora kinase A (AURKA) activity. Nongenetic resistance through the activation of AURKA by its coactivator TPX2 emerges in response to chronic EGFR inhibition where it mitigates drug-induced apoptosis. Aurora kinase inhibitors suppress this adaptive survival program, increasing the magnitude and duration of EGFR inhibitor response in preclinical models. Treatment-induced activation of AURKA is associated with resistance to EGFR inhibitors in vitro, in vivo and in most individuals with EGFR-mutant lung adenocarcinoma. These findings delineate a molecular path whereby drug resistance emerges from drug-tolerant cells and unveils a synthetic lethal strategy for enhancing responses to EGFR inhibitors by suppressing AURKA-driven residual disease and acquired resistance.

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Fig. 1: EGFR-mutant lung adenocarcinoma cells that demonstrate acquired resistance to third-generation EGFR TKIs are sensitive to Aurora kinase inhibition.
Fig. 2: Activation of AURKA is sufficient to cause resistance to EGFR TKIs, and drug combinations induce apoptosis through BIM upregulation in vitro and in vivo.
Fig. 3: EGFR inhibition leads to the activation of TPX2 and AURKA during establishment of drug tolerance where it is necessary for survival and emergence of acquired resistance in vitro.
Fig. 4: Clinical potential of combined EGFR and Aurora kinase inhibition on residual disease and acquired resistance.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files. Cell lines generated in this study are available upon reasonable request from the authors.


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We thank members of the Bandyopadhyay laboratory for helpful discussions and technical assistance. We also thank J. Gordon from the LCA microscopy core for technical assistance and reagents. This work was supported by National Cancer Institute grant nos. U01CA168370 (S.B.), NIGMS R01GM107671 (S.B.), R01CA169338 (T.G.B) and U54CA224081 (S.B., T.G.B).

Author information

Project conception: K.N.S. and S.B. Performance of experiments: K.N.S., R.B., J.W., J. Rotow, J. Rohrberg, V.E.W., H.J.D., J.G., V.O., G.H., M.M.M., A.M., J.K., H.J.H., L.R. and G.K. Data analysis and interpretation: K.N.S., H.J.D., S.K., A.K., S.D. and G.K. Manuscript writing: K.N.S. and S.B. Manuscript finalization: all authors. Study supervision: T.C.H., A.D.S., F.M., A.G., C.M.B., T.G.B and S.B. Funding: S.B.

Correspondence to Sourav Bandyopadhyay.

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Competing interests

H.J.H., L.R., A.D.S. and T.C.H. are employees of Clovis Oncology. S.B. recieves funding and/or has a consultancy relationship with Ideaya Biosciences and Pfizer.

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Supplementary information

Supplementary Text and Figures

Supplementary Figures 1–11

Reporting Summary

Supplementary Table 1

Results of drug synergy screen

Supplementary Table 2

Mitotic defects after EGFR TKI treatment

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Shah, K.N., Bhatt, R., Rotow, J. et al. Aurora kinase A drives the evolution of resistance to third-generation EGFR inhibitors in lung cancer. Nat Med 25, 111–118 (2019) doi:10.1038/s41591-018-0264-7

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