Gefitinib, a small molecule inhibitor of the
epidermal growth factor receptor tyrosine kinase, has been shown to induce autophagy as well as apoptosis in
tumor cells. Yet, how to use autophagy and apoptosis to improve therapeutic efficacy of this
drug against
cancer remains to be explored. We reported here that
MK-2206, a potent allosteric Akt inhibitor currently in phase I trials in patients with solid
tumors, could reinforce the cytocidal effect of
gefitinib against
glioma. We found that cotreatment with
gefitinib and
MK-2206 increased the cytotoxicity of this
growth factor receptor inhibitor in the
glioma cells, and the CompuSyn synergism/antagonism analysis showed that
MK-2206 acted synergistically with
gefitinib. The benefit of the combinatorial treatment was also shown in an intracranial
glioma mouse model. In the presence of
MK-2206, there was a significant increase in apoptosis in
glioma cells treated with
gefitinib.
MK-2206 also augmented the autophagy-inducing effect of
gefitinib, as evidenced by increased levels of the autophagy marker, LC3-II. Inhibition of autophagy by silencing of the key autophagy gene,
beclin 1 or 3-MA, further increased the cytotoxicity of this combinatorial treatment, suggesting that autophagy induced by these agents plays a cytoprotective role. Notably, at 48 hours following the combinatorial treatment, the level of LC3-II began to decrease but Bim was significantly elevated, suggesting a switch from autophagy to apoptosis. On the basis of the synergistic effect of
MK-2206 on
gefitinib observed in this study, the combination of these two drugs may be utilized as a new therapeutic regimen for
malignant glioma.