Figure 10: Model of induction of apoptosis and adaptive resistance in response to ErbB2 blockade.

(a) Overexpression of ErbB2 is sufficient to activate ErbB2 and ErbB3 in the absence of ligands and drives tumour growth predominantly via the ErbB2/ErbB3/PI3K/AKT signalling axis. This signalling route constitutively suppresses negative feedback regulation between AKT and ErbB3, which is however relieved upon blockade of ErbB2/3 receptors or the downstream signalling pathways. (b) Trastuzumab treatment induces partial ErbB2 blockade by selectively interfering with the ligand-independent ErbB2/ErbB3 heterodimers, thereby uncoupling ErbB3 from PI3K/AKT reactivation. Here we identified a novel adaptation response that emanates from ErbB2/RAS and bypasses ErbB3 for the activation of PI3K/AKT signalling. (c) Biparatopic DARPins obstruct all ligand-dependent and ligand-independent complexes of ErbB2. Such a pan-ErbB2 inhibition blocks PI3K/AKT signalling cascade and consecutive adaptive responses, leading to a stable OFF state of the ErbB oncogenic network. Consequently, intrinsic apoptosis is induced which prevents emergence of adaptive resistance.