Identification of mutations associated with acquired resistance to sunitinib in renal cell cancer

Mohamed Elgendy, Juan Pablo Fusco, Victor Segura, Maria Dolores Lozano, Saverio Minucci, Jose Ignacio Echeveste, Alfonso Gurpide, Mapi Andueza, Ignacio Melero, Miguel F. Sanmamed, Maria Rodriguez Ruiz, Alfonso Calvo, Juan Ignacio Pascual, Jose María Velis, Bernardino Miñana, Ricardo Diez Valle, Ruben Pio, Jackeline Agorreta, Marta Abengozar, Maurizio ColecchiaSilvia Brich, Salvatore Lorenzo Renne, Elisabet Guruceaga, Ana Patiño-García, Jose Luis Perez-Gracia

Research output: Contribution to journalArticlepeer-review


Sunitinib is one of the most widely used targeted therapeutics for renal cell carcinoma (RCC), but acquired resistance against targeted therapies remains a major clinical challenge. To dissect mechanisms of acquired resistance and unravel reliable predictive biomarkers for sunitinib in RCC, we sequenced the exons of 409 tumor-suppressor genes and oncogenes in paired tumor samples from an RCC patient, obtained at baseline and after development of acquired resistance to sunitinib. From newly arising mutations, we selected, using in silico prediction models, six predicted to be deleterious, located in G6PD, LRP1B, SETD2, TET2, SYNE1, and DCC. Consistently, immunoblotting analysis of lysates derived from sunitinib-desensitized RCC cells and their parental counterparts showed marked differences in the levels and expression pattern of the proteins encoded by these genes. Our further analysis demonstrates essential roles for these proteins in mediating sunitinib cytotoxicity and shows that their loss of function renders tumor cells resistant to sunitinib in vitro and in vivo. Finally, sunitinib resistance induced by continuous exposure or by inhibition of the six proteins was overcome by treatment with cabozantinib or a low-dose combination of lenvatinib and everolimus. Collectively, our results unravel novel markers of acquired resistance to sunitinib and clinically relevant approaches for overcoming this resistance in RCC.

Original languageEnglish
Pages (from-to)1991-2001
Number of pages11
JournalInternational Journal of Cancer
Issue number7
Publication statusPublished - Jan 1 2019


  • biomarkers
  • DCC
  • G6PD
  • LRP1B
  • MCL-1
  • mTORC1
  • renal cell carcinoma
  • resistance
  • SETD2
  • sunitinib
  • SYNE1
  • TET2

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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