Abstract 4743: Targeting a novel TWIST1-Hexokinase II pathway to overcome MET TKI resistance in NSCLC

Abstract Non-small cell lung cancer (NSCLC) is the most common primary tumor to metastasize to the brain, with up to 40% of NSCLC patients developing brain metastases (BM). These BM portend a poor prognosis, even when extracranial disease is well-controlled. While targeted therapy and immunotherapy have improved lung cancer survival, there are no therapies specifically targeting NSCLC BM. Our lab identified a significant enrichment of MET amplification in lung adenocarcinoma (LUAD) BM (16%) compared to primary NSCLC (3%) and liver metastases (5%). MET, a receptor tyrosine kinase, and its ligand, hepatocyte growth factor (HGF), promote proliferation, epithelial-mesenchymal transition (EMT), angiogenesis, and metastasis. Although MET tyrosine kinase inhibitors (TKIs) are approved for use in METaltered NSCLC, half of patients with MET alterations fail to respond or inevitably acquire TKI resistance. We have found that MET pathway activation by MET alterations leads to increased expression of TWIST1, an EMT transcription factor required for tumorigenesis in MET-dependent NSCLC. Together, the HGF/MET/TWIST1 axis promotes cancer survival and metastasis. We found that MET amplified BM had distinct transcriptional signatures reflecting increased glycolysis. A similar shift toward glycolysis was observed in the MET amplified metastatic LUAD cell line (H1993) compared to the MET wild type primary LUAD line (H2073) derived from the same patient. Furthermore, LUAD cell lines with high MET expression demonstrated increased expression and activity of glycolytic enzymes, as well as increased susceptibility to glucose deprivation and glycolytic inhibitors (2DG, PFK158, AT-101, V-9302). Conversely, treatment of MET amplified cells with MET TKI, capmatinib, reduced glycolysis and oxidation phosphorylation to the levels observed in MET wild type LUAD lines. Activation of the MET pathway with HGF or TWIST1 overexpression specifically increased the mRNA and protein expression of the key glycolytic enzyme, Hexokinase II (HK2), compared to other glycolytic pathway proteins. Conversely, inhibition of the MET pathway with capmatinib or the TWIST1 inhibitor, harmine, decreased HK2 protein expression through a MYC-independent pathway. However, TWIST1 was required for MET-dependent transcriptional upregulation of HK2. Remarkably, in two novel MET altered models (cell line and patient derived xenograft) of acquired MET TKI resistance, TWIST1 and HK2 expression were increased at the time of resistance. Both models remained sensitive to pharmacologic inhibition of either TWIST1 or glycolysis at the time of acquired resistance to MET TKIs. These findings suggest that continued upregulation of the TWIST1-HK2 axis is required for acquired MET TKI resistance. In summary, these studies suggest a targetable, metabolic reprogramming in MET altered LUAD BM mediated through a novel TWIST1-HK2 pathway. Citation Format: Purva H. Rumde, Kasey R. Cargill, Vinod Kumar, Princey Devadassan, Jason Chen, Leviticus McGraw-Sapp, Xiaxuan Wu, Sanja Dacic, Riyue Bao, Bharathri Sivakama, Eric S. Goetzman, Sameer Agnihotri, Steven J. Mullett, Stacey G. Wendell, Laura P. Stabile, Timothy F. Burns. Targeting a novel TWIST1-Hexokinase II pathway to overcome MET TKI resistance in NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4743.