Altered Regulation of HIF-1α in Naive- and Drug-Resistant EGFR-Mutant NSCLC: Implications for a Vascular Endothelial Growth Factor-Dependent Phenotype

Monique B. Nilsson, Jacqulyne Robichaux, Matthew H. Herynk, Tina Cascone, Xiuning Le, Yasir Elamin, Sonia Patel, Fahao Zhang, Li Xu, Limei Hu, Lixia Diao, Li Shen, Junqin He, Xiaoxing Yu, Petros Nikolinakos, Pierre Saintigny, Bingliang Fang, Luc Girard, Jing Wang, John D. MinnaIgnacio I. Wistuba, John V. Heymach

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Introduction: The treatment of patients with EGFR-mutant NSCLC with vascular endothelial growth factor (VEGF) inhibitors in combination with EGFR inhibitors provides a greater benefit than EGFR inhibition alone, suggesting that EGFR mutation status may define a patient subgroup with greater benefit from VEGF blockade. The mechanisms driving this potentially enhanced VEGF dependence are unknown. Methods: We analyzed the effect of EGFR inhibition on VEGF and HIF-1α in NSCLC models in vitro and in vivo. We determined the efficacy of VEGF inhibition in xenografts and analyzed the impact of acquired EGFR inhibitor resistance on VEGF and HIF-1α. Results: NSCLC cells with EGFR-activating mutations exhibited altered regulation of VEGF compared with EGFR wild-type cells. In EGFR-mutant cells, EGFR, not hypoxia, was the dominant regulator of HIF-1α and VEGF. NSCLC tumor models bearing classical or exon 20 EGFR mutations were more sensitive to VEGF inhibition than EGFR wild-type tumors, and a combination of VEGF and EGFR inhibition delayed tumor progression. In models of acquired EGFR inhibitor resistance, whereas VEGF remained overexpressed, the hypoxia-independent expression of HIF-1α was delinked from EGFR signaling, and EGFR inhibition no longer diminished HIF-1α or VEGF expression. Conclusions: In EGFR-mutant NSCLC, EGFR signaling is the dominant regulator of HIF-1α and VEGF in a hypoxia-independent manner, hijacking an important cellular response regulating tumor aggressiveness. Cells with acquired EGFR inhibitor resistance retained elevated expression of HIF-1α and VEGF, and the pathways were no longer EGFR-regulated. This supports VEGF targeting in EGFR-mutant tumors in the EGFR inhibitor–naive and refractory settings.

Original languageEnglish (US)
Pages (from-to)439-451
Number of pages13
JournalJournal of Thoracic Oncology
Issue number3
StatePublished - Mar 2021


  • Epidermal growth factor receptor
  • Hypoxia-inducible factor
  • Non–small cell lung cancer
  • Vascular endothelial growth factor

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


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