NF-kB inhibition by bortezomib permits IFN-g-Activated RIP1 kinase-dependent necrosis in renal cell carcinoma

Advanced renal cell carcinoma (RCC) is an invariably fatal cancer. Currently, small-molecule inhibitors that target cell growth, angiogenesis, or nutrient-sensing pathways represent the primary pharmacologic interventions for this disease, but these inhibitors only delay tumor progression and are not curative. The cytokine IFN-g showed the potential to provide lasting remission in several phase I/II trials for advanced RCCs, but subsequent trials, including a multicenter phase III study using IFN-g as a monotherapy for RCCs, were less promising. Notably, these trials were designed to exploit the indirect immunomodulatory effects of IFN-g, whereas its direct antitumor properties-including its ability to trigger programmed cell death in tumors- remain mostly untapped. Here, we show that the proteasome inhibitor bortezomib (PS-341, Velcade) sensitizes otherwise resistant RCC cells to direct necrotic death by IFN-g. Mechanistically, we show that bortezomib functions, at least in part, by inhibiting prosurvival NF-kB signaling. In the absence of this signal, IFN-g triggers programmed necrosis (or "necroptosis") dependent on the kinase RIP1. When taken together with the observation that NF-kB signaling is elevated in RCCs, these results provide rationale for the combined use of IFN-g and bortezomib in the treatment of metastatic RCCs. Mol Cancer Ther; 12(8); 1568-78.