mTOR kinase inhibition effectively decreases progression of a subset of neuroendocrine tumors that progress on rapalog therapy and delays cardiac impairment

Melissa A. Orr-Asman, Zhengtao Chu, Min Jiang, Mariah Worley, Kathleen LaSance, Sheryl E. Koch, Vinicius S. Carreira, Hanan M. Dahche, David R. Plas, Kakajan Komurov, Xiaoyang Qi, Carol A. Mercer, Lowell B. Anthony, Jack Rubinstein, Hala E. Thomas

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Inhibition of mTOR signaling using the rapalog everolimus is an FDA-approved targeted therapy for patients with lung and gastroenteropancreatic neuroendocrine tumors (NET). However, patients eventually progress on treatment, highlighting the need for additional therapies. We focused on pancreatic NETs (pNET) and reasoned that treatment of these tumors upon progression on rapalog therapy, with an mTOR kinase inhibitor (mTORKi), such as CC-223, could overcome a number of resistance mechanisms in tumors and delay cardiac carcinoid disease. We performed preclinical studies using human pNET cells in vitro and injected them subcutaneously or orthotopically to determine tumor progression and cardiac function in mice treated with either rapamycin alone or switched to CC-223 upon progression. Detailed signaling and RNA sequencing analyses were performed on tumors that were sensitive or progressed on mTOR treatment. Approximately 57% of mice bearing pNET tumors that progressed on rapalog therapy showed a significant decrease in tumor volume upon a switch to CC-223. Moreover, mice treated with an mTORKi exhibited decreased cardiac dilation and thickening of heart valves than those treated with placebo or rapamycin alone. In conclusion, in the majority of pNETs that progress on rapalogs, it is possible to reduce disease progression using an mTORKi, such as CC-223. Moreover, CC-223 had an additional transient cardiac benefit on valvular fibrosis compared with placebo- or rapalog-treated mice. These results provide the preclinical rationale to further develop mTORKi clinically upon progression on rapalog therapy and to further test their long-term cardioprotective benefit in those NET patients prone to carcinoid syndrome.

Original languageEnglish
Pages (from-to)2432-2441
Number of pages10
JournalMolecular Cancer Therapeutics
Issue number11
StatePublished - Nov 2017

Bibliographical note

Funding Information:
This work was supported by grants to H.E.Thomas from the NANETS (YIA award), Just-in-Time funding from the Cincinnati Cancer Center, the Department of Internal Medicine Junior Faculty Pilot Project Award and Division of Hematology and Oncology Translational Science Awards. The UC Genomics, Epigenomics and Sequencing Core is partially funded by an NIEHS CEG administrative core grant P30ES006096.

Publisher Copyright:
©2017 AACR.

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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