Research Papers:

Combinatorial drug screening identifies compensatory pathway interactions and adaptive resistance mechanisms

Mark J Axelrod, Vicki Gordon, Mark Conaway, Adel Tarcsafalvi, Daniel J Neitzke, Daniel Gioeli and Michael J Weber _

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Oncotarget. 2013; 4:622-635. https://doi.org/10.18632/oncotarget.938

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Mark Axelrod1, Vicki L. Gordon1, Mark Conaway2, Adel Tarcsafalvi1,3, Daniel J. Neitzke1,4, Daniel Gioeli1, and Michael J. Weber1

1 Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, USA

2 Department of Public Health Sciences, University of Virginia, Charlottesville, USA

3 Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA

4 Medical Scientist Training Program, Medical University of South Carolina, Charleston, USA


Michael J. Weber, email:

Keywords: Targeted therapies, Compensatory signaling, Pathway interactions, Crosstalk, Feedback inhibition

Received: March 15, 2013 Accepted: April 9, 2013 Published: April 10, 2013


Constitutively activated signaling molecules are often the primary drivers of malignancy, and are favored targets for therapeutic intervention. However, the effectiveness of targeted inhibition of cell signaling can be blunted by compensatory signaling which generates adaptive resistance mechanisms and reduces therapeutic responses. Therefore, it is important to identify and target these compensatory pathways with combinations of targeted agents to achieve durable clinical benefit. In this report, we demonstrate the use of high-throughput combinatorial drug screening as a discovery tool to identify compensatory pathways that generate resistance to the cytotoxic effects of targeted therapy. We screened 420 drug combinations in 14 different cell lines representing three cancer lineages, and assessed the ability of each combination to cause synergistic cytotoxicity. Drug substitution studies were used to validate the functionally important drug targets. Of the 84 combinations that caused robust synergy in multiple cell lines, none were synergistic in more than half of the lines tested, and we observed no pattern of lineage specificity in the observed synergies. This reflects the plasticity of cell signaling networks, even among cell lines of the same tissue of origin. Mechanistic analysis of one novel synergistic combination identified in the screen, the multi-kinase inhibitor Ro31-8220 and lapatinib, demonstrated compensatory crosstalk between the p70S6 kinase and EGF receptor pathways. In addition, we identified BAD as a node of convergence between these two pathways that may be playing a role in the enhanced apoptosis observed upon combination treatment.

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