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Review | Open Access

Biological insights in non-small cell lung cancer

Rafael Rosell1,2( ), Anisha Jain3, Jordi Codony-Servat4, Eloisa Jantus-Lewintre5, Blake Morrison6, Jordi Barretina Ginesta1, María González-Cao2
Germans Trias i Pujol Research Institute, Badalona 08028, Spain
IOR, Hospital Quiron-Dexeus, Barcelona 08028, Spain
Department of Microbiology, JSS Academy of Higher Education & Research, Mysuru 570015, India
Pangaea Oncology, Hospital Quiron-Dexeus, Barcelona 08028, Spain
Department of Biotechnology, Universitat Politècnica de Valencia; Mixed Unit TRIAL (General University Hospital of Valencia Research Foundation and Príncipe Felipe Research Center), CIBERONC, Valencia 46014, Spain
Sumitomo Pharma Oncology, Inc., Cambridge, MA and Lehi, UT 84043, USA
Show Author Information

Abstract

Lung oncogenesis relies on intracellular cysteine to overcome oxidative stress. Several tumor types, including non-small cell lung cancer (NSCLC), upregulate the system xc- cystine/glutamate antiporter (xCT) through overexpression of the cystine transporter SLC7A11, thus sustaining intracellular cysteine levels to support glutathione synthesis.

Nuclear factor erythroid 2-related factor 2 (NRF2) serves as a master regulator of oxidative stress resistance by regulating SLC7A11, whereas Kelch-like ECH-associated protein (KEAP1) acts as a cytoplasmic repressor of the oxidative responsive transcription factor NRF2. Mutations in KEAP1/NRF2 and p53 induce SLC7A11 activation in NSCLC. Extracellular cystine is crucial in supplying the intracellular cysteine levels necessary to combat oxidative stress. Disruptions in cystine availability lead to iron-dependent lipid peroxidation, thus resulting in a type of cell death called ferroptosis. Pharmacologic inhibitors of xCT (either SLC7A11 or GPX4) induce ferroptosis of NSCLC cells and other tumor types. When cystine uptake is impaired, the intracellular cysteine pool can be sustained by the transsulfuration pathway, which is catalyzed by cystathionine-B-synthase (CBS) and cystathionine g-lyase (CSE). The involvement of exogenous cysteine/cystine and the transsulfuration pathway in the cysteine pool and downstream metabolites results in compromised CD8+ T cell function and evasion of immunotherapy, diminishing immune response and potentially reducing the effectiveness of immunotherapeutic interventions. Pyroptosis is a previously unrecognized form of regulated cell death. In NSCLCs driven by EGFR, ALK, or KRAS, selective inhibitors induce pyroptotic cell death as well as apoptosis. After targeted therapy, the mitochondrial intrinsic apoptotic pathway is activated, thus leading to the cleavage and activation of caspase-3. Consequently, gasdermin E is activated, thus leading to permeabilization of the cytoplasmic membrane and cell-lytic pyroptosis (indicated by characteristic cell membrane ballooning). Breakthroughs in KRAS G12C allele-specific inhibitors and potential mechanisms of resistance are also discussed herein.

Keywords

ferroptosispyroptosisnon-small cell lung cancer (NSCLC)nuclear factor erythroid 2-related factor 2 (NRF2)Solute carrier family 7 member 11 (SLC7A11)KRAS G12C allele-specific inhibitors

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Cancer Biology & Medicine
Volume 20 Issue 7,
July 2023
Pages 500-518
DOI: 10.20892/j.issn.2095-3941.2023.0108
Cite this article:
Rosell R, Jain A, Codony-Servat J, et al. Biological insights in non-small cell lung cancer. Cancer Biology & Medicine, 2023, 20(7): 500-518. https://doi.org/10.20892/j.issn.2095-3941.2023.0108

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Received: 04 April 2023
Accepted: 05 June 2023
Published: 28 June 2023
©2023 Cancer Biology & Medicine.

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