Investigating multi-drug resistance in lung cancer using metabolomics and cell biology

Osimertinib is a 1st-line treatment for non-small cell lung cancer (NSCLC) developed by AstraZeneca to inhibit mutated epithelial growth factor receptor (EGFRm). A challenge with Osimertinib treatment is the eventual development of drug resistance in a significant number of patients. A multi-omic approach is being used to characterize a number of pathways leading to the resistant state, and this information is being translated to the clinic, where treatments bypassing the acquired drug resistance are being tested. Unfortunately, resistance to Osimertinib is highly heterogeneous, and moreover a significant proportion of relapsed patients have unknown drivers of resistance.
It is known that Osimertinib-sensitive cells suppress glycolysis and have an increased dependence on oxidative phosphorylation in the presence of drug. Conversely, resistant cells maintain their glycolytic metabolism during drug treatment, and have variable sensitivities to oxidative phopshorylation inhibitors. However, little is known about changes to the basal metabolism of EGFRm NSCLC cells as they progress to resistance beyond these global energy pathways. Furthermore, genetic alterations that drive resistance in relapsed patients (e.g. PIK3CA mutation) are known to regulate metabolic pathways. This necessitates the better understanding of the metabolic changes occurring as cancer cells gain Osimertinib resistance.