LAUSR

Abstract We aimed to develop novel drug combination strategy to overcome drug resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) in the treatment of non‐small cell lung cancer (NSCLC). Peroxisome proliferator‐activated receptor gamma (PPAR&ggr;) is a nuclear receptor, which upon activation upregulates phosphatase and tensin homolog (PTEN) to inhibit cell signaling downstream of PI3K to mediate apoptosis. To this end, PTEN loss is a known mechanism contributing to resistance to EGFR TKIs. Therefore, PPAR&ggr; agonists are hypothesized to overcome EGFR TKI resistance. Using human NSCLC cell models with PTEN deficiency, the potentiation of EGFR TKI anticancer activity by PPAR&ggr; agonists was evaluated. PPAR&ggr; agonists were found to upregulate PTEN, subsequently inhibiting the PI3K‐Akt signaling pathway, and thus enhancing the anticancer activity of gefitinib (a first generation EGFR TKI). Chemical and genetic inhibition of PPAR&ggr; were shown to prevent this potentiation of anticancer activity by PPAR&ggr; agonists, thus confirming the crucial role played by PPAR&ggr; activation. Interestingly, the tested PPAR&ggr; agonists were also found to induce autophagy, as evidenced by the increased expression of an autophagy marker LC3‐II and the autophagic degradation of p62/SQSTM1. PPAR&ggr; agonists‐induced autophagic cell death was believed to contribute to the circumvention of resistance in PTEN‐deficient cells because the genetic silencing of ATG5 (an autophagy mediator) was found to eliminate the drug potentiation effect by the PPAR&ggr; agonists. Our findings thus provide the basis for the rational and personalized use of PPAR&ggr; agonists in combination with EGFR TKIs in lung cancer patients.