Bisantrene potentiates tyrosine kinase inhibitor activity in clear cell renal cell carcinoma

Clear Cell Renal Cell Carcinoma (ccRCC) is the most prevalent kidney cancer and often develops resistance to standard therapies. This study aimed to assess if bisantrene, a multi-mechanistic agent with broad anticancer activity, can enhance the activity of standard of care ccRCC treatments. A panel of ccRCC cell lines were treated with bisantrene alone and in combination with common ccRCC drugs. Bisantrene showed moderate activity as a single agent, but strongly synergized with several ccRCC treatments, especially the tyrosine kinase inhibitors (TKIs) lenvatinib, pazopanib and cabozantinib. Cellular signaling pathways assessed by immunoblotting revealed the TKIs inhibit MET as well as downstream AKT and ERK signaling pathways as single agents. Combination of these TKIs with bisantrene was able to induce sustained downstream AKT inhibition and negate the rebound effect seen with TKI resistance. Overall, bisantrene shows promise as a new therapeutic agent for ccRCC in combination with TKIs.