CAV2 Modulates Cetuximab Sensitivity in HNSCC via Ubiquitin-Mediated Disruption of the PACT-PKR Axis

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) often exhibits limited clinical response to targeted therapies, such as Cetuximab. Identifying key drivers of tumor progression and elucidating the factors that modulate therapeutic sensitivity are essential for improving clinical outcomes. In this study, we aimed to investigate the role of CAV2 in HNSCC proliferation and its impact on Cetuximab sensitivity. Methods: Prognosis-associated genes in HNSCC were screened using the The Cancer Genome Atlas (TCGA) database. The functional role of Caveolin-2 (CAV2) in cell proliferation and apoptosis was assessed via Cell Counting Kit-8 (CCK-8), colony formation, and flow cytometry assays. Mechanistic insights were obtained through co-immunoprecipitation, ubiquitination assays, and proteomic analysis. The impact of CAV2 on Cetuximab sensitivity was evaluated both in vitro and in a xenograft mouse model. Results: Clinical analysis of 43 pairs of HNSCC tumor and adjacent normal tissues revealed that elevated CAV2 expression was significantly associated with poor prognosis in HNSCC patients (95%CI: 1.197–1.7518, p = 1.33 × 10−13). In vitro, knockdown of CAV2 suppressed cell proliferation and significantly increased apoptosis rates (from 5.1% to 10.8%, p = 0.004). Mechanistically, CAV2 interacted with the PACT protein and disrupted the PACT-PKR axis via the ubiquitin–proteasome pathway. Notably, CAV2 deficiency synergized with Cetuximab treatment, reducing the the half maximal inhibitory concentration (IC50) value by 6-fold compared with control cells and suppressing tumor growth by 48.41% in xenograft models compared to Cetuximab monotherapy (p < 0.0001). Conclusions: In conclusion, these findings establish CAV2 as a critical regulator of HNSCC progression and Cetuximab sensitivity via post-translational modulation of the PACT–PKR axis. Targeting the CAV2/PACT/PKR axis may therefore represent a promising therapeutic strategy to potentiate the efficacy of EGFR-targeted therapy in patients with HNSCC.