The majority of
gastrointestinal stromal tumors (GIST) are characterized by activating mutations of KIT, an HSP90 client
protein. Further secondary resistance mutations within KIT limit clinical responses to
tyrosine kinase inhibitors, such as
imatinib. The dependence of KIT and its mutated forms on HSP90 suggests that HSP90 inhibition might be a valuable treatment option for GIST, which would be equally effective on
imatinib-sensitive and -resistant clones. We investigated the activity of
AT13387, a potent HSP90 inhibitor currently being evaluated in clinical trials, in both in vitro and in vivo GIST models.
AT13387 inhibited the proliferation of
imatinib-sensitive (GIST882, GIST-T1) and -resistant (GIST430, GIST48) cell lines, including those resistant to the
geldanamycin analogue HSP90 inhibitor,
17-AAG. Treatment with
AT13387 resulted in depletion of HSP90 client
proteins, KIT and AKT, along with their phospho-forms in
imatinib-sensitive and -resistant cell lines, irrespective of KIT mutation. KIT signaling was ablated, whereas HSP70, a marker of HSP90 inhibition, was induced. In vivo, antitumor activity of
AT13387 was showed in both the
imatinib-sensitive, GIST-PSW, xenograft model and a newly characterized
imatinib-resistant, GIST430, xenograft model. Induction of HSP70, depletion of phospho-KIT and inhibition of KIT signaling were seen in
tumors from both models
after treatment with
AT13387. A combination of
imatinib and
AT13387 treatment in the
imatinib-resistant GIST430 model significantly enhanced
tumor growth inhibition over either of the monotherapies. Importantly, the combination of
AT13387 and
imatinib was well tolerated. These results suggest
AT13387 is an excellent candidate for clinical testing in GIST in combination with
imatinib.