Exp Hematol Oncol. 2025 May 26. 14(1): 79
Jeffrey Xiao,
Joshua Kim,
Brandon Park,
David J Baylink,
Cedric Kwon,
Victoria Tran,
Scott Lee,
Kevin Codorniz,
Laren Tan,
Pamela Lobo Moreno,
Amy Schill-Depew,
Saied Mirshahidi,
David De Semir,
Diana Hanna,
Kiran Naqvi,
Huynh Cao,
Chien-Shing Chen,
Joanne Xiu,
Heinz-Josef Lenz,
Hamid Mirshahidi,
Mark E Reeves,
Yi Xu.
Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignancy with a 5-year overall survival (OS) rate of approximately 12%. More than 90% of PDAC patients harbor oncogenic mutations in the Kirsten rat sarcoma viral homolog (KRAS) gene. MRTX1133 (MRTX), a novel inhibitor of KRASG12D (the most common KRAS mutation found in pancreatic and colon cancers) has shown promise as a therapeutic agent. To address reported resistance to MRTX, we adapted our anti-leukemia co-targeting strategy and evaluated a combination of MRTX and Bedaquiline (BED), an FDA-approved inhibitor of mitochondrial ATP production, in in vitro human PDAC models. The combination of MRTX and BED demonstrated enhanced cytotoxic effects by disrupting all 11 genes within the DNA helicase family (CMG complex: CDC45-MCM-GINS), which are essential for initiating DNA replication and regulating cell cycle progression. Notably, real-world data analysis from Caris Life Sciences and NCI-TCGA database revealed that low transcriptomic expression of the DNA helicase CMG complex was significantly associated with prolonged survival (e.g., low CDC45 expression and low GINS2 expression with greater than 8 months longer overall survival) in PDAC patients with KRASG12 mutations (N = 9,717; P < 0.00001). However, this combination therapy also triggered strong pro-survival nuclear reprogramming. This effect was mediated by significant genetic activation of an NFκB2-DDIT (DNA damage-induced transcript) axis, which supported tumor chromosomal integrity and DNA repair mechanisms. To overcome NFκB2-driven resistance mechanisms, we explored a triple-targeting strategy that addresses metabolic and genomic plasticity in addition to actively intercepting cell division. This approach combines MRTX1133, Bedaquiline, and the NFκB2 inhibitor SN52, offering a novel therapeutic avenue to treat aggressive pancreatic cancer and potentially improve patient outcomes.
Keywords: ATP; Bedaquiline; DDIT; Helicase; KRAS; MRTX1133; Mitochondrion; NFκB2; PDAC; S100P