Spatially coordinated RTK-ERK signaling dynamics shape osteosarcoma single-cell drug response in the lung microenvironment
Lung metastases are the leading cause of death in osteosarcoma, where treatment response reflects interactions between genetic, phenotypic, and tumor-host environmental influences. This study investigated how dynamic receptor tyrosine kinase (RTK)-ERK signaling contributes to phenotypic drug response heterogeneity. Using live-cell time-lapse microscopy and data-driven dynamical modeling, we resolved ERK activity, FOSL1/Fra-1 reporter expression, and cell fate in biosensor-expressing osteosarcoma lung metastases ex vivo following MCL1 inhibitor exposure. RTK inhibitors were subsequently evaluated for their ability to suppress adaptive signaling and enhance therapeutic response ex vivo and in vivo. MCL1 inhibition induced extensive tumor-cell death but also enriched for persistent ERK-high/Fra-1 high reporter cells enriched at the tumor-lung interface. Experimental and computational analyses revealed that tumor-cell lysis amplified fibroblast growth factor receptor (FGFR)-mediated ERK signaling in neighboring cells, promoting an adaptive drug-resistant state associated with FOSL1/Fra-1 expression and upregulation of the drug-resistance pathways Nrf2 and HMOX1. Combining MCL1 inhibition with the FGFR inhibitor fexagratinib or broad-spectrum RTK inhibitor pazopanib suppressed adaptive ERK activation and enhanced treatment efficacy ex vivo and in vivo. Together, these findings identify tumor-host interactions and lysis-induced FGFR-ERK signaling as drivers of spatiotemporally heterogeneous adaptive resistance in metastatic osteosarcoma, supporting combinatorial RTK targeting to improve therapeutic response.