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Novel Approach to Overcome Osimertinib Resistance Using Bromodomain and Extra-Terminal Domain Inhibitors.

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This study reveals that fibroblast growth factor 1 (FGF1) drives resistance to osimertinib in lung cancer by altering chromatin. Combining bromodomain inhibitors with osimertinib overcomes this resistance, offering a new therapeutic strategy.

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Area of Science:

  • Oncology
  • Molecular Biology
  • Epigenetics

Background:

  • Osimertinib is a first-line treatment for EGFR-mutated lung cancer, but resistance mechanisms are not fully understood.
  • Epigenetic dysregulation is suspected in drug resistance, yet specific pathways remain unclear.

Purpose of the Study:

  • To investigate the role of epigenetics in osimertinib resistance in lung cancer.
  • To explore the therapeutic potential of targeting epigenetic modifications to overcome osimertinib resistance.

Main Methods:

  • Established osimertinib-resistant lung cancer cell lines.
  • Utilized assay for transposase-accessible chromatin using sequencing (ATAC-seq) and RNA sequencing to analyze chromatin accessibility and gene expression.
  • Investigated the role of fibroblast growth factor 1 (FGF1) and histone modifications.
  • Tested combination therapy with bromodomain and extra-terminal domain (BET) inhibitors and osimertinib in vitro and in vivo.

Main Results:

  • Significant changes in chromatin accessibility were observed in resistant cells.
  • FGF1 was identified as a resistance-related gene regulated by histone modifications.
  • FGF1 overexpression induced osimertinib resistance, while its suppression attenuated resistance.
  • Combination therapy with BET inhibitors and osimertinib effectively overcame resistance in cell lines and mouse xenograft models.
  • Increased FGF1 expression was found in clinical osimertinib-resistant samples.

Conclusions:

  • Epigenetic alterations, specifically involving histone modifications regulating FGF1, play a crucial role in osimertinib resistance.
  • Targeting histone modifications with BET inhibitors represents a promising novel strategy to overcome osimertinib resistance in lung cancer.
  • FGF1 is a potential therapeutic target for overcoming osimertinib resistance.