Microenvironment-derived HGF overcomes genetically determined sensitivity to anti-MET drugs

Cell-based drug screenings indicate that tumors displaying c-MET gene amplification are ‘addicted’ to MET signaling and therefore very sensitive to MET-targeted agents. However, these screenings were conducted in the absence of the MET ligand, Hepatocyte Growth Factor (HGF), which is abundant in the tumor microenvironment. Sensitivity of 6 MET-addicted human tumor cells to 3 MET kinase inhibitors (JNJ-38877605, PHA-665752, crizotinib) and 1 antagonistic anti-MET antibody (DN30 Fab) was analyzed in the absence or presence of HGF, in a stroma-tumor co-culture system, and by combining anti-MET drugs with a HGF-neutralizing antibody (ficlatuzumab) in human HGF knock-in mice bearing c-MET-amplified tumors. In all models examined, HGF promoted resistance to MET-targeted agents, affecting both their potency and efficacy. HGF-induced resistance was due to restoration of physiologic, GAB-1-mediated PI3K activation that compensated for loss of aberrant, HER3-dependent PI3K signaling. Ficlatuzumab restored sensitivity to MET-targeted agents in co-culture systems and overcame resistance to JNJ-38877605, crizotinib and DN30 Fab in human HGF knock-in mice. These data suggest that c-MET-amplified tumor cells -which normally exhibit ligand-independent, constitutive MET activation- become dependent on HGF for survival upon pharmacological MET inhibition. Since HGF is frequently overexpressed in human cancer, this mechanism may represent a major cause of resistance to anti-MET therapies. The ability of ficlatuzumab to overcome HGF-mediated resistance generates proof-of-principle that vertical inhibition of both a tyrosine kinase receptor and its ligand can be therapeutically beneficial, and opens new perspectives for the treatment of MET-dependent tumors.