Targeting Resistance against the MDM2 Inhibitor RG7388 in Glioblastoma Cells by the MEK Inhibitor Trametinib
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Abstract
Purpose: Resistance is an obstacle of glioma therapy. Despite targeted interventions, tumors harbor primary resistance or become resistant over short course of treatment. This study examined the mouse double minute 2 (MDM2) inhibitor RG7388 together with radiotherapy and analyzed strategies to overcome acquired MDM2 inhibitor resistance in glioblastoma. Experimental Design: Effects of RG7388 and radiotherapy were analyzed in p53 wild-type glioblastoma cell lines and glioma-initiating cells. RG7388 resistant cells were generated by increasing RG7388 doses over 3 months. Regulated pathways were investigated by microarray, qRT-PCR, and immunoblot analysis and specifically inhibited to evaluate rational salvage therapies at RG7388 resistance. Effects of RG7388 and trametinib treatment were challenged in an orthotopical mouse model with RG7388 resistant U87MG glioblastoma cells. Results: MDM2 inhibition required functional p53 and showed synergistic activity with radiotherapy in first-line treatment. Long-term exposure to RG7388 induced resistance by activation of the extracellular signal-regulated kinases 1/2 (ERK1/2)–insulin growth factor binding protein 1 (IGFBP1) signaling cascade, which was specifically overcome by ERK1/2 pathway inhibition with trametinib and knockdown of IGFBP1. Combining trametinib with continued RG7388 treatment enhanced antitumor effects at RG7388 resistance in vitro and in vivo. Conclusions: These data provide a rationale for combining RG7388 and radiotherapy as first-line therapy with a specific relevance for tumors insensitive to alkylating standard chemotherapy and for the addition of trametinib to continued RG7388 treatment as salvage therapy after acquired resistance against RG7388 for clinical practice.
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SAR405838, RG7112, and idasanutlin have shown efficacy in GBM preclinical models.
“Several MDM2 inhibitors have shown efficacy in GBM preclinical models, including SAR405838 (7), RG7112 (8), idasanutlin (RG7388; ref. 9)”
From Preclinical Modeling of Navtemadlin Pharmacokinetics, Pharmacodynamics, and Efficacy in IDH–Wild-type Glioblastoma (2025) · cites this paper as [9]
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- Authors
- Berberich, A., Kessler, T., Thomé, C. M., Pusch, S., Hielscher, T., Sahm, F., Oezen, I., Schmitt, L.-M., Ciprut, S., Hucke, N., Ruebmann, P., Fischer, M., Lemke, D., Breckwoldt, M. O., von Deimling, A., Bendszus, M., Platten, M., & Wick, W.
- Affiliations
- German Cancer Research Center (DE)
- University Hospital Heidelberg (DE)
- 3Clinical Cooperation Unit Neuropathology, DKTK, DKFZ, Heidelberg, Germany.
- Corresponding author
- Wick, Wolfgang
- ORCID
- Venue
- Clinical Cancer Research
- Published
- 2019-01-01
- Volume
- 25
- Issue
- 1
- Pages
- 253-265
- ISSN
- 1078-0432 (ISSN-L)
- 1557-3265
- OpenAlex
- W2895467863
- Cited by
- 75
- References
- 42
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 9 · 2023: 11 · 2022: 10 · 2021: 15 · 2020: 9 · 2019: 6
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Cancer Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- DKFZ (G370)
- Topics
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
- Health Sciences › Medicine › Pathology and Forensic Medicine › Cancer Mechanisms and Therapy
- Keywords
- RG7388, MDM2 inhibitors, glioblastoma, acquired drug resistance, trametinib, MEK inhibition, ERK signaling, IGFBP-1, combined radiotherapy, p53, glioma stem cells, salvage therapy, U87 cells
- MeSH terms
- Animals, Antineoplastic Combined Chemotherapy Protocols, Glioblastoma, Humans, Pyridones, Pyrimidinones, Pyrrolidines, Signal Transduction, Tumor Suppressor Protein p53, Insulin-Like Growth Factor Binding Protein 1, Drug Resistance, Neoplasm, Cell Line, Tumor, Mice, Proto-Oncogene Proteins c-mdm2, para-Aminobenzoates, Heterografts
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