HER3 Augmentation via Blockade of EGFR/AKT Signaling Enhances Anticancer Activity of HER3-Targeting Patritumab Deruxtecan in EGFR-Mutated Non-Small Cell Lung Cancer.

Abstract

EGFR-tyrosine kinase inhibitor (TKI) is a standard first-line therapy for activated <i>EGFR</i>-mutated non-small cell lung cancer (NSCLC). Treatment options for patients with acquired EGFR-TKI resistance are limited. HER3 mediates EGFR-TKI resistance. Clinical trials of the HER3-targeting antibody-drug conjugate patritumab deruxtecan (HER3-DXd) demonstrated its anticancer activity in <i>EGFR</i>-mutated NSCLC; however, the mechanisms that regulate HER3 expression are unknown. This study was conducted with the aim to clarify the mechanisms underlying HER3 regulation in <i>EGFR</i>-mutated NSCLC tumors and explored the strategy for enhancing the anticancer activity of HER3-DXd in <i>EGFR</i>-mutated NSCLC. Paired tumor samples were obtained from 48 patients with <i>EGFR</i>-mutated NSCLC treated with EGFR-TKI(s). HER3 expression was immunohistochemically quantified with H-score, and genomic alteration and transcriptomic signature were tested in tumors from pretreatment to post-EGFR-TKI resistance acquisition. The anticancer efficacy of HER3-DXd and osimertinib was evaluated in <i>EGFR</i>-mutated NSCLC cells. We showed augmented HER3 expression in <i>EGFR</i>-mutated tumors with acquired EGFR-TKI resistance compared with paired pretreatment samples. RNA sequencing revealed that repressed PI3K/AKT/mTOR signaling was associated with HER3 augmentation, especially in tumors from patients who received continuous EGFR-TKI therapy. An <i>in vitro</i> study also showed that EGFR-TKI increased HER3 expression, repressed AKT phosphorylation in multiple <i>EGFR</i>-mutated cancers, and enhanced the anticancer activity of HER3-DXd. Our findings help clarify the mechanisms of HER3 regulation in <i>EGFR</i>-mutated NSCLC tumors and highlight a rationale for combination therapy with HER3-DXd and EGFR-TKI in <i>EGFR</i>-mutated NSCLC.