WEE1 confers resistance to KRASG12C inhibitors in non-small cell lung cancer

Abstract

KRAS^G12C inhibitors sotorasib and adagrasib have been approved for the treatment of KRAS^G12C-mutant non-small cell lung cancer (NSCLC). However, the efficacy of single-agent treatments is limited, presumably due to multiple resistance mechanisms. To overcome these therapeutic limitations, combination strategies that potentiate the antitumor efficacy of KRAS^G12C inhibitors must be developed. Through unbiased high-throughput screening of 1395 kinase inhibitors, we identified adavosertib, a WEE1 inhibitor, as a promising combination partner of sotorasib. The combination of sotorasib and adavosertib exhibited synergistic antiproliferative activities both in vitro and in vivo, irrespective of TP53, STK11, and KEAP1 co-mutation profiles. WEE1 inhibition potentiated MCL-1-mediated apoptosis in sotorasib-treated cancer cells. Mechanistically, the combination downregulated MCL-1 protein levels by attenuating de novo translation and enhancing its degradation. WEE1 overexpression conferred resistance against sotorasib via MCL-1 upregulation. Moreover, cells that acquired sotorasib resistance profoundly upregulated both WEE1 and MCL-1 proteins, highlighting WEE1 as a crucial driver of sotorasib resistance. Importantly, WEE1 inhibition re-sensitized resistant cells to sotorasib treatment. The current findings demonstrate that combined inhibition of KRAS^G12C and WEE1 not only exhibits synergistic antitumor efficacy but also overcomes resistance to KRAS^G12C inhibitors, thus representing a novel therapeutic strategy for KRAS^G12C-mutant NSCLC.

Keywords: Adavosertib; Apoptosis; Combination therapy; Drug resistance; MCL-1; Sotorasib.