Reference Detail

Ref Type

Journal Article

PMID

(30730307)

Authors

Stivala S, Codilupi T, Brkic S, Baerenwaldt A, Ghosh N, Hao-Shen H, Dirnhofer S, Dettmer MS, Simillion C, Kaufmann BA, Chiu S, Keller M, Kleppe M, Hilpert M, Buser AS, Passweg JR, Radimerski T, Skoda RC, Levine RL, Meyer SC

Title

Targeting compensatory MEK/ERK activation increases JAK inhibitor efficacy in myeloproliferative neoplasms.

Journal	Vol	Issue	Date	Pages	Journal Short Title
The Journal of clinical investigation	129	4	2019 03 04	1596-1611	J Clin Invest

URL

Abstract Text

Constitutive JAK2 signaling is central to myeloproliferative neoplasm (MPN) pathogenesis and results in activation of STAT, PI3K/AKT, and MEK/ERK signaling. However, the therapeutic efficacy of current JAK2 inhibitors is limited. We investigated the role of MEK/ERK signaling in MPN cell survival in the setting of JAK inhibition. Type I and II JAK2 inhibition suppressed MEK/ERK activation in MPN cell lines in vitro, but not in Jak2V617F and MPLW515L mouse models in vivo. JAK2 inhibition ex vivo inhibited MEK/ERK signaling, suggesting that cell-extrinsic factors maintain ERK activation in vivo. We identified PDGFRα as an activated kinase that remains activated upon JAK2 inhibition in vivo, and PDGF-AA/PDGF-BB production persisted in the setting of JAK inhibition. PDGF-BB maintained ERK activation in the presence of ruxolitinib, consistent with its function as a ligand-induced bypass for ERK activation. Combined JAK/MEK inhibition suppressed MEK/ERK activation in Jak2V617F and MPLW515L mice with increased efficacy and reversal of fibrosis to an extent not seen with JAK inhibitors. This demonstrates that compensatory ERK activation limits the efficacy of JAK2 inhibition and dual JAK/MEK inhibition provides an opportunity for improved therapeutic efficacy in MPNs and in other malignancies driven by aberrant JAK-STAT signaling.

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Molecular Profile	Treatment Approach

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description	Associated with drug Resistance

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
JAK2 V617F	polycythemia vera	sensitive	Binimetinib + Ruxolitinib	Preclinical	Actionable	In a preclinical study, Jakafi (ruxolitinib) and Mektovi (binimetinib) combination treatment resulted in increased inhibition of Erk phosphorylation and signaling, decreased splenomegaly, hematocrit, and reticulocytes, and decreased bone marrow fibrosis in a mouse model of polycythemia vera harboring JAK2 V617F compared to either drug alone (PMID: 30730307).	30730307
JAK2 V617F	myelofibrosis	sensitive	Binimetinib + Ruxolitinib	Preclinical - Patient cell culture	Actionable	In a preclinical study, Jakafi (ruxolitinib) and Mektovi (binimetinib) combination treatment resulted in enhanced inhibition of colony growth in bone marrow and peripheral blood mononuclear cells (PBMCs) derived from myelofibrosis patients harboring JAK2 V617F in culture compared to Jakafi (ruxolitinib) alone (PMID: 30730307).	30730307
JAK2 V617F	polycythemia vera	sensitive	Binimetinib + CHZ868	Preclinical	Actionable	In a preclinical study, CHZ868 and Mektovi (binimetinib) combination treatment decreased splenomegaly, reticulocytes, hematocrit, and allele burden, and reduced expansion of progenitor cells, an effect not observed with treatment of either agent alone, in a mouse model of polycythemia vera harboring JAK2 V617F (PMID: 30730307).	30730307