The described important roles for SFKs in CRC tumorigenesis indicate that they may be valuable therapeutic targets for the treatment of this cancer. Several ATP-competitive inhibitors that target SFKs have been developed and three of them are currently evaluated in clinical trials [
11]. These are the SFK inhibitor saracatinib, the SRC/ABL inhibitor bosutinib and the multi-kinase inhibitor dasatinib that also target SFKs [
10]. In accordance with a role for SFKs in cell proliferation, these inhibitors reduce the growth rate of CRC cell lines; however, their biological activity seems to be highly dependent on the type of cell line or primary tumor grafted in nude mice. For example, dasatinib and saracatinib inhibited cell proliferation in less than 20% of the CRC cell lines under study [
23,
110]. In accordance with a specific biological effect of these molecules, growth inhibition correlated with the level of SKF deregulation [
23]. This preclinical data, thus, suggests that these drugs will have a therapeutic activity only on a small fraction of CRC, probably those with highly deregulated SFK activity. Conversely, SFK inhibition by other means has a wider effect on cell proliferation [
40,
111]. For example,
YES silencing by using a specific shRNA strategy reduced proliferation and induced apoptosis of CRC cells, an effect that has not been reported with the available clinical SFK inhibitors [
9]. This difference could simply be explained by the conditions used to test cell proliferation (standard versus anchorage-independent growth). Moreover, the incomplete inhibition of the different SFK family members by these inhibitors may leave a residual activity that is sufficient to maintain a transformed phenotype. Therefore, a better pharmacological response is required, possibly by using inhibitors that target efficiently all SFKs within the cell, including those present in lipid rafts, by exploiting the affinity of some compounds for the lipophilic micro-environment. Nevertheless, this strategy may not inhibit SKF kinase-independent signaling which has also been reported in CRC cells [
9,
112]. In this case, a combined therapeutic approach in which both SFKs and their downstream substrates are targeted might inhibit SFK oncogenic signaling more efficiently. This strategy has been recently validated by using dasatinib in nilotinib-resistant chronic myeloid leukemia [
113,
114].
In contrast to their weak effect on primary tumor growth, SFK inhibitors have a strong impact on CRC cell migration and invasion [
40,
83,
110,
115]. We thus anticipate that these agents might be particularly useful for the treatment of metastatic CRC, specifically to reduce cell dissemination during tumor progression and/or surgery. Moreover, these inhibitors could also hinder CRC metastatic growth and angiogenesis, as observed in the case of liver metastases in nude mice treated with dasatinib [
107]. Therefore, these molecules could improve the standard therapy for patients with metastatic CRC. Indeed, dasatinib in combination with oxaliplatin had a remarkable synergistic effect in a murine model of liver metastases from colorectal cancer [
107]. The shrinkage of the metastatic nodules was due to reduction of angiogenesis and induction of apoptosis. This remarkable effect was probably mediated by the oxidative stress induced by oxaliplatin, leading to a very robust SFK activation. Such SFK activation could be due to inhibition of regulatory tyrosine phosphatases and/or, possibly, to direct SFK activation by ROS. This idea is supported by the finding that ROS can trigger oxidation of cysteine residues within the SRC sequence, leading to stabilization of the protein in its open and active conformation [
116]. Clearly, the combination of SFK inhibitors with oxaliplatin deserves further investigation.
Finally, SFK inhibitors could also improve existing targeted therapies. For example, anti-EGFR antibodies, such as cetuximab, can significantly improve survival in patients with CRC. However, clinical investigations have demonstrated a strong correlation between the therapeutic response to anti-EGFR antibodies and the status of KRAS as no response was observed in tumors with mutated KRAS. Therefore, cetuximab is currently proposed only to patients with tumors harboring wild type KRAS [
11]. The underlying mechanism of tumor resistance is still unclear, but it has been proposed that oncogenic KRAS induces constitutive MAPK and probably PI3K signaling pathways that are no longer dependent on EGFR activity. Therefore, in these cancers, EGFR inhibition will not inhibit MAPK effect on cancer cell growth. Interestingly, dasatinib can sensitize CRC cells with mutant KRAS to cetuximab in preclinical models, leading to anti-proliferative effects on tumor growth [
117]. Whether this combination reduces metastatic growth as well has not been addressed. This synergistic effect has been attributed to SFK inhibitory effects on the AKT/mTOR, beta-Catenin and STAT oncogenic pathways. These data indicate that mutated KRAS alone is not sufficient to ensure tumor growth and that RTKs and SFKs play additional important roles in this process. A similar mechanism may also be at play in CRC with oncogenic PI3K [
118].
Although not demonstrated, the synergistic activity of these drugs may be explained by a more efficient inhibition of the oncogenic signaling pathways that operate in CRC cells. This hypothesis implies that oncogenic signaling must be inhibited to a sufficient level in order to trigger a cell response. Due to the pleiotropic activity of SFKs on the major oncogenic signaling pathways that drive CRC tumor progression, a combination of SFK inhibitors should improve RTK-based targeted therapy. Similarly, the observed interplay between SFKs and RTKs in regulating the invasiveness of metastatic CRC cells suggests that SFK-based therapies might also be improved by the use of a combination of inhibitors that target these downstream TKs in advanced CRC. Therefore, the characterization of the TK signaling network that operates during metastasis formation will have important implications in the design of novel SFK-based therapeutic strategies for metastatic CRC. It can thus be easily anticipated that a combination of appropriate therapeutic agents that target TK oncogenic signaling pathways, including SFKs, may be of therapeutic value in this deadly disease.