Most non-small-cell
lung cancers (NSCLCs) harboring activating mutations in the
epidermal growth factor receptor (EGFR) are initially responsive to EGFR
tyrosine kinase inhibitors (EGFR-TKIs); however, they invariably develop resistance to these drugs.
E7820 is an
angiogenesis inhibitor that decreases integrin-α2 expression and is currently undergoing clinical trials. We investigated whether
E7820 in combination with
erlotinib, an EGFR-TKI, could overcome EGFR-TKI-resistance in the NSCLC cell lines A549 (KRAS; G12S), H1975 (EGFR; L858R/T790M), and H1650 (PTEN; loss, EGFR; exon 19 deletion), which are resistant to
erlotinib. Immunohistochemical analysis was carried out in xenografted
tumors to investigate anti-angiogenesis activity and endothelial cell apoptosis levels by endothelial cell marker CD31 and TUNEL staining, respectively. Treatment with
E7820 (50 mg/kg) with
erlotinib (60 mg/kg) showed a synergistic antitumor effect in three xenograft models. Immunohistochemical analysis indicated that combined treatment with
E7820 and
erlotinib significantly decreased microvessel density and increased apoptosis of
tumor-associated endothelial cells compared with use of only one of the agents. This combination increased apoptosis in HUVECs through activation of both intrinsic and extrinsic apoptosis pathways in vitro. The combination of
E7820 with
erlotinib is an alternative strategy to overcome
erlotinib resistance in NSCLC by enhancement of the anti-angiogenic activity of
E7820.