Novel Toll-Like Receptor 9 Agonist Induces Epidermal Growth Factor Receptor (EGFR) Inhibition and Synergistic Antitumor Activity with EGFR Inhibitors
Abstract
Purpose: Immunostimulating Toll-like receptor 9 (TLR9) agonists cause antitumor activity interfering also with cancer proliferation and angiogenesis by mechanisms still incompletely understood. We hypothesized that modified TLR9 agonists could impair epidermal growth factor receptor (EGFR) signaling and, by this means, greatly enhance EGFR inhibitors effect, acting on both the receptor targeting and the immunologic arm. Experimental Design: We used a novel second-generation, modified, immunomodulatory TLR9 agonist (IMO), alone and in combination with the anti-EGFR monoclonal antibody cetuximab or tyrosine kinase inhibitor gefitinib, on the growth of GEO and cetuximab-resistant derivatives GEO-CR colon cancer xenografts. We have also evaluated the expression of several proteins critical for cell proliferation, apoptosis, and angiogenesis, including EGFR, mitogen-activated protein kinase, Akt, bcl-2, cyclooxygenase-2, vascular endothelial growth factor, and nuclear factor-κB. Results: IMO inhibited GEO growth and signaling by EGFR and the other proteins critical for cell proliferation and angiogenesis. IMO plus the anti-EGFR antibody cetuximab synergistically inhibited tumor growth, signaling proteins, and microvessel formation. EGFR signaling inhibition by IMO is relevant because IMO cooperated also with EGFR tyrosine kinase inhibitor gefitinib in GEO tumors, while it was inactive against GEO-CR xenografts. On the other hand, IMO boosted the non-EGFR-dependent cetuximab activity, causing a cooperative antitumor effect in GEO-CR cells. Finally, combination of IMO, cetuximab and chemotherapeutic irinotecan eradicated the tumors in 90% of mice. Conclusion: IMO interferes with EGFR-related signaling and angiogenesis and has a synergistic antitumor effect with EGFR inhibitors, especially with cetuximab, boosting both the EGFR dependent and independent activity of this agent. Moreover, this therapeutic strategy could be translated in patients affected by colorectal cancer.
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IMO was proven to synergistically inhibit tumour growth by improving the ADCC activity of cetuximab in a cetuximab-resistant colorectal cancer line and a mouse model regardless of KRAS genotype.
“IMO is a novel second-generation, modified, immunomodulatory TLR9 agonist and was proven to synergistically inhibit tumour growth by improving the ADCC activity of cetuximab in a cetuximab-resistant colorectal cancer line and a mouse model regardless of KRAS genotype [55, 56].”
From Resistance to anti-EGFR therapies in metastatic colorectal cancer: underlying mechanisms and reversal strategies (2021) · cites this paper as [55]
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- Authors
- Damiano, V., Caputo, R., Bianco, R., D'Armiento, F. P., Leonardi, A., De Placido, S., Bianco, A. R., Agrawal, S., Ciardiello, F., & Tortora, G.
- Affiliations
- 1Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica,
- 5Oncotech, Naples, Italy; and
- 2Istituto di Anatomia Patologica, and
- University of Naples Federico II (IT)
- Idera Pharmaceuticals (United States) (US)
- University of Campania "Luigi Vanvitelli" (IT)
- ORCID
- Venue
- Clinical Cancer Research
- Published
- 2006-01-15
- Volume
- 12
- Issue
- 2
- Pages
- 577-583
- ISSN
- 1078-0432 (ISSN-L)
- 1557-3265
- OpenAlex
- W2140724157
- Cited by
- 90
- References
- 37
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 1 · 2014: 8 · 2013: 7 · 2012: 6
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Cancer Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Keywords
- Toll-like receptor 9 agonist, EGFR signaling inhibition, cetuximab, gefitinib, cetuximab resistance, colorectal cancer, colon cancer xenografts, angiogenesis, combination cancer therapy, irinotecan, mitogen-activated protein kinase, Akt, NF-κB, cyclooxygenase-2, vascular endothelial growth factor
- MeSH terms
- Cetuximab, Animals, Antibodies, Monoclonal, Antineoplastic Agents, Colonic Neoplasms, Drug Synergism, Drug Therapy, Combination, Humans, Mice, Inbred BALB C, Mice, Nude, Neovascularization, Pathologic, Oligonucleotides, Transplantation, Heterologous, Signal Transduction, NF-kappa B, Drug Resistance, Neoplasm, Proto-Oncogene Proteins c-bcl-2, Mitogen-Activated Protein Kinases, Vascular Endothelial Growth Factor A, Cell Proliferation, Proto-Oncogene Proteins c-akt, Toll-Like Receptor 9, Mice, Cyclooxygenase 2, Antibodies, Monoclonal, Humanized, ErbB Receptors
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