Lapatinib is a human epidermal growth factor receptor 2 (HER2) tyrosine kinase inhibitor (TKI) that has clinical activity in HER2-amplified breast cancer. In vitro studies have shown that lapatinib enhances the effects of the monoclonal antibody trastuzumab suggesting partially nonoverlapping mechanisms of action. To dissect these mechanisms, we have studied the effects of lapatinib and trastuzumab on receptor expression and receptor signaling and have identified a new potential mechanism for the enhanced antitumor activity of the combination. Lapatinib, given alone or in combination with trastuzumab to HER2-overexpressing breast cancer cells SKBR3 and MCF7-HER2, inhibited HER2 phosphorylation, prevented receptor ubiquitination and resulted in a marked accumulation of inactive receptors at the cell surface. By contrast, trastuzumab alone caused enhanced HER2 phosphorylation, ubiquitination and degradation of the receptor. By immunoprecipitation and computational protein modeling techniques we have shown that the lapatinib-induced HER2 accumulation at the cell surface also results in the stabilization of inactive HER2 homo-(HER2/HER2) and hetero-(HER2/EGFR and HER2/HER3) dimers. Lapatinibinduced accumulation of HER2 and trastuzumab-mediated downregulation of HER2 was also observed in vivo, where the combination of the two agents triggered complete tumor remissions in all cases after 10 days of treatment. Accumulation of HER2 at the cell surface by lapatinib enhanced immune-mediated trastuzumab-dependent cytotoxicity. We propose that this is a novel mechanism of action of the combination that may be clinically relevant and exploitable in the therapy of patients with HER2-positive tumors.

HER2 is a tyrosine kinase receptor causally involved in cancer. A subgroup of breast cancer patients with particularly poor clinical outcomes expresses a heterogeneous collection of HER2 carboxy-terminal fragments (CTFs). However, since the CTFs lack the extracellular domain that drives dimerization and subsequent activation of full-length HER2, they are in principle expected to be inactive. Here we show that at low expression levels one of these fragments, 611-CTF, activated multiple signaling pathways because of its unanticipated ability to constitutively homodimerize. A transcriptomic analysis revealed that 611-CTF specifically controlled the expression of genes that we found to be correlated with poor prognosis in breast cancer. Among the 611-CTF-regulated genes were several that have previously been linked to metastasis, including those for MET, EPHA2, matrix metalloproteinase 1, interleukin 11, angiopoietin-like 4, and different integrins. It is thought that transgenic mice overexpressing HER2 in the mammary glands develop tumors only after acquisition of activating mutations in the transgene. In contrast, we show that expression of 611-CTF led to development of aggressive and invasive mammary tumors without the need for mutations. These results demonstrate that 611-CTF is a potent oncogene capable of promoting mammary tumor progression and metastasis.HER2 (ErbB2) is a type I transmembrane protein that belongs to the epidermal growth factor receptor (EGFR, ErbB1, HER1) family. Two additional members, HER3 and -4 (ErbB3 and -4), complete this family. When an EGF-like ligand binds to HER1, -3, or -4, its extracellular domain adopts the socalled open conformation, which allows the formation of homo-or heterodimers (5). Despite not binding any ligand, HER2 readily interacts with other ligand-bound HER receptors because its extracellular domain is constitutively in an open conformation (10).At the cell surface, dimerization of the extracellular domains leads to interaction between the intracellular kinases of the HER receptors and subsequent transphosphorylation of tyrosine residues in the C-terminal tails. The phosphotyrosines act as docking sites for proteins that initiate signals which are transduced to the nucleus through different pathways, including the mitogen-activated protein kinases (MAPKs), phosphoinositide-3-kinase-activated Akt, Src, and phospholipase C gamma (PLCgamma) pathways. These signaling circuitries control the expression of target genes that act coordinately to modify key aspects of cellular biology, including proliferation, migration, survival, and differentiation (7).In addition to the canonical mode, HER receptors or fragments of them are capable of direct signaling. For example, a nuclear carboxy-terminal fragment (CTF) encompassing the entire cytoplasmic domain of HER4 has been shown to regulate gene transcription (22,39). The CTF of HER4 is generated at the plasma membrane by the sequential action of two types of proteolytic enzymes known as the alpha-and gammasecretases. Alpha-secre...

A subtype of HER2-positive tumors with distinct biological and clinical features expresses a series of carboxyterminal fragments collectively known as p95HER2. One of these fragments, named 100-to 115-kDa p95HER2 or 611-CTF, is hyperactive because of its ability to form homodimers maintained by intermolecular disulfide bonds. Despite lacking the majority of the extracellular domain, this HER2 fragment drives breast cancer progression in vivo. The recent availability of specific anti-p95 antibodies has confirmed previous results indicating that the expression of p95HER2 is predictive of poor prognosis and correlates with resistance to the treatment with trastuzumab, a therapeutic antibody directed against the extracellular domain of HER2.