Cooperative targeting of melanoma heterogeneity with an AXL antibody-drug conjugate and BRAF/MEK inhibitors
Abstract
Intratumor heterogeneity is a key factor contributing to therapeutic failure and, hence, cancer lethality. Heterogeneous tumors show partial therapy responses, allowing for the emergence of drug-resistant clones that often express high levels of the receptor tyrosine kinase AXL. In melanoma, AXL-high cells are resistant to MAPK pathway inhibitors, whereas AXL-low cells are sensitive to these inhibitors, rationalizing a differential therapeutic approach. We developed an antibody-drug conjugate, AXL-107-MMAE, comprising a human AXL antibody linked to the microtubule-disrupting agent monomethyl auristatin E. We found that AXL-107-MMAE, as a single agent, displayed potent in vivo anti-tumor activity in patient-derived xenografts, including melanoma, lung, pancreas and cervical cancer. By eliminating distinct populations in heterogeneous melanoma cell pools, AXL-107-MMAE and MAPK pathway inhibitors cooperatively inhibited tumor growth. Furthermore, by inducing AXL transcription, BRAF/MEK inhibitors potentiated the efficacy of AXL-107-MMAE. These findings provide proof of concept for the premise that rationalized combinatorial targeting of distinct populations in heterogeneous tumors may improve therapeutic effect, and merit clinical validation of AXL-107-MMAE in both treatment-naive and drug-resistant cancers in mono- or combination therapy.
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In melanoma, tumor cells treated with targeted therapy underwent a lineage transition to an undifferentiated mesenchymal cell state leading to drug tolerance and eventually resistance.
“In melanoma, tumor cells treated with targeted therapy underwent a lineage transition to an undifferentiated mesenchymal cell state leading to drug tolerance and eventually resistance [48,80,81].”
From Emerging Insights into Targeted Therapy-Tolerant Persister Cells in Cancer (2021) · cites this paper as [80]
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Targeting HER2-AXL heterodimerization to overcome resistance to HER2 blockade in breast cancer
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AXL Receptor in Cancer Metastasis and Drug Resistance: When Normal Functions Go Askew
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Cancer Cell Phenotype Plasticity as a Driver of Immune Escape in Melanoma
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- Authors
- Boshuizen, J., Koopman, L. A., Krijgsman, O., Shahrabi, A., van den Heuvel, E. G., Ligtenberg, M. A., Vredevoogd, D. W., Kemper, K., Kuilman, T., Song, J.-Y., Pencheva, N., Mortensen, J. T., Foppen, M. G., Rozeman, E. A., Blank, C. U., Janmaat, M. L., Satijn, D., Breij, E. C. W., Peeper, D. S., & Parren, P. W. H. I.
- Affiliations
- The Netherlands Cancer Institute (NL)
- Genmab (Netherlands) (NL)
- Leiden University Medical Center (NL)
- Corresponding author
- Breij, Esther C W
- Peeper, Daniel S
- ORCID
- Venue
- Nature Medicine
- Published
- 2018-01-15
- Volume
- 24
- Issue
- 2
- Pages
- 203-212
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- OpenAlex
- W2783011222
- Cited by
- 229
- References
- 64
- Citations by year
- 2026: 16 · 2025: 12 · 2024: 19 · 2023: 38 · 2022: 29 · 2021: 35 · 2020: 39 · 2019: 28 · 2018: 13
- FWCI
- 10.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Medicine (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Melanoma and MAPK Pathways
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Degradation and Inhibitors
- Keywords
- melanoma, AXL receptor tyrosine kinase, antibody-drug conjugates, monomethyl auristatin E, BRAF/MEK inhibitors, MAPK pathway inhibitors, tumor heterogeneity, drug resistance, combination therapy, patient-derived xenografts, receptor tyrosine kinase
- MeSH terms
- Axl Receptor Tyrosine Kinase, Animals, Humans, Melanoma, Oligopeptides, Proto-Oncogene Proteins, Genetic Heterogeneity, Immunoconjugates, Drug Resistance, Neoplasm, Receptor Protein-Tyrosine Kinases, Xenograft Model Antitumor Assays, Cell Line, Tumor, Protein Kinase Inhibitors, Proto-Oncogene Proteins B-raf, Mice
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