Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

Kirsten L. Bryant, Clint A. Stalnecker, Daniel Zeitouni, Jennifer E. Klomp, Sen Peng, Andrey P. Tikunov, Venugopal Gunda, Mariaelena Pierobon, Andrew M. Waters, Samuel D. George, Garima Tomar, Björn Papke, G. Aaron Hobbs, Liang Yan, Tikvah K. Hayes, J. Nathaniel Diehl, Gennifer D. Goode, Nina V. Chaika, Yingxue Wang, Guo Fang ZhangAgnieszka K. Witkiewicz, Erik S. Knudsen, Emanuel F. Petricoin, Pankaj K. Singh, Jeffrey M. Macdonald, Nhan L. Tran, Costas A. Lyssiotis, Haoqiang Ying, Alec C. Kimmelman, Adrienne D. Cox, Channing J. Der*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

461 Scopus citations


Pancreatic ductal adenocarcinoma (PDAC) is characterized by KRAS- and autophagy-dependent tumorigenic growth, but the role of KRAS in supporting autophagy has not been established. We show that, to our surprise, suppression of KRAS increased autophagic flux, as did pharmacological inhibition of its effector ERK MAPK. Furthermore, we demonstrate that either KRAS suppression or ERK inhibition decreased both glycolytic and mitochondrial functions. We speculated that ERK inhibition might thus enhance PDAC dependence on autophagy, in part by impairing other KRAS- or ERK-driven metabolic processes. Accordingly, we found that the autophagy inhibitor chloroquine and genetic or pharmacologic inhibition of specific autophagy regulators synergistically enhanced the ability of ERK inhibitors to mediate antitumor activity in KRAS-driven PDAC. We conclude that combinations of pharmacologic inhibitors that concurrently block both ERK MAPK and autophagic processes that are upregulated in response to ERK inhibition may be effective treatments for PDAC.

Original languageEnglish
Pages (from-to)628-640
Number of pages13
JournalNature Medicine
Issue number4
StatePublished - 1 Apr 2019
Externally publishedYes


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