• Ryohei Katayama, Takuya Sakashita, Noriko Yanagitani, Hironori Ninomiya, Atsushi Horiike, Luc Friboulet, Justin F Gainor, Noriko Motoi, Akito Dobashi, Seiji Sakata, Yuichi Tambo, Satoru Kitazono, Shigeo Sato, Sumie Koike, John Iafrate A A Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA., Mari Mino-Kenudson, Yuichi Ishikawa, Alice T Shaw, Jeffrey A Engelman, Kengo Takeuchi, Makoto Nishio, and Naoya Fujita.
• Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan. Electronic address: ryohei.katayama@jfcr.or.jp.
• EBioMedicine. 2016 Jan 1; 3: 54-66.

AbstractThe anaplastic lymphoma kinase (ALK) fusion oncogene is observed in 3%-5% of non-small cell lung cancer (NSCLC). Crizotinib and ceritinib, a next-generation ALK tyrosine kinase inhibitor (TKI) active against crizotinib-refractory patients, are clinically available for the treatment of ALK-rearranged NSCLC patients, and multiple next-generation ALK-TKIs are currently under clinical evaluation. These ALK-TKIs exhibit robust clinical activity in ALK-rearranged NSCLC patients; however, the emergence of ALK-TKI resistance restricts the therapeutic effect. To date, various secondary mutations or bypass pathway activation-mediated resistance have been identified, but large parts of the resistance mechanism are yet to be identified. Here, we report the discovery of p-glycoprotein (P-gp/ABCB1) overexpression as a ceritinib resistance mechanism in ALK-rearranged NSCLC patients. P-gp exported ceritinib and its overexpression conferred ceritinib and crizotinib resistance, but not to PF-06463922 or alectinib, which are next-generation ALK inhibitors. Knockdown of ABCB1 or P-gp inhibitors sensitizes the patient-derived cancer cells to ceritinib, in vitro and in vivo. P-gp overexpression was identified in three out of 11 cases with in ALK-rearranged crizotinib or ceritinib resistant NSCLC patients. Our study suggests that alectinib, PF-06463922, or P-gp inhibitor with ceritinib could overcome the ceritinib or crizotinib resistance mediated by P-gp overexpression.

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