Resistance to currently available targeted
therapies significantly hampers the survival of patients with
prostate cancer with bone
metastasis. Here we demonstrate an important resistance mechanism initiated from
tumor-induced bone. Studies using an osteogenic patient-derived xenograft, MDA-PCa-118b, revealed that
tumor cells resistant to
cabozantinib, a Met and
VEGFR-2 inhibitor, reside in a "resistance niche" adjacent to
prostate cancer-induced bone. We performed secretome analysis of the
conditioned medium from
tumor-induced bone to identify
proteins (termed "osteocrines") found within this resistance niche. In accordance with previous reports demonstrating that activation of
integrin signaling pathways confers therapeutic resistance, 27 of the 90 osteocrines identified were
integrin ligands. We found that following
cabozantinib treatment, only
tumor cells positioned adjacent to the newly formed woven bone remained viable and expressed high levels of pFAK-Y397 and pTalin-S425, mediators of
integrin signaling. Accordingly, treatment of C4-2B4 cells with
integrin ligands resulted in increased pFAK-Y397 expression and cell survival, whereas targeting
integrins with FAK inhibitors
PF-562271 or
defactinib inhibited FAK phosphorylation and reduced the survival of PC3-mm2 cells. Moreover, treatment of MDA-PCa-118b
tumors with
PF-562271 led to decreased
tumor growth, irrespective of initial
tumor size. Finally, we show that upon
treatment cessation, the combination of
PF-562271 and
cabozantinib delayed
tumor recurrence in contrast to
cabozantinib treatment alone. Our studies suggest that identifying paracrine de novo resistance mechanisms may significantly contribute to the generation of a broader set of potent therapeutic tools that act combinatorially to inhibit metastatic
prostate cancer.