Combined Pan-RAF and MEK Inhibition Overcomes Multiple Resistance Mechanisms to Selective RAF Inhibitors.
| Authors | |
| Abstract | RAF and MEK inhibitors are effective in BRAF-mutant melanoma but not in BRAF-mutant colorectal cancer. To gain additional insights into this difference, we performed a genome-scale pooled shRNA enhancer screen in a BRAF-mutant, RAF inhibitor-resistant colorectal cancer cell line exposed to the selective RAF inhibitor PLX4720. We identified multiple genes along the receptor tyrosine kinase (RTK)/mitogen-activated protein kinase (MAPK) signaling axis that, when suppressed, either genetically or pharmacologically, sensitized cells to the selective RAF inhibitor through sustained inhibition of MAPK signaling. Strikingly, CRAF was a key mediator of resistance that could be overcome by the use of pan-RAF inhibitors in combination with a MEK inhibitor. Furthermore, the combination of pan-RAF and MEK inhibitors displayed strong synergy in melanoma and colorectal cancer cell lines with RAS-activating events such as RTK activation, KRAS mutation, or NF1 loss-of-function mutations. Combinations of selective RAF inhibitors, such as PLX4720 or dabrafenib, with MEK inhibitors did not incur such profound synergy, suggesting that inhibition of CRAF by pan-RAF inhibitors plays a key role in determining cellular response. Importantly, in contrast to the modest activity seen with single-agent treatment, dual pan-RAF and MEK inhibition results in the induction of apoptosis, greatly enhancing efficacy. Notably, combined pan-RAF and MEK inhibition can overcome intrinsic and acquired resistance to single-agent RAF/MEK inhibition, supporting dual pan-RAF and MEK inhibition as a novel therapeutic strategy for BRAF- and KRAS-mutant cancers. |
| Year of Publication | 2015
|
| Journal | Mol Cancer Ther
|
| Volume | 14
|
| Issue | 12
|
| Pages | 2700-11
|
| Date Published | 2015 Dec
|
| ISSN | 1538-8514
|
| DOI | 10.1158/1535-7163.MCT-15-0136-T
|
| PubMed ID | 26351322
|
| PubMed Central ID | PMC4674359
|
| Links | |
| Grant list | 5P50CA127003-05 / CA / NCI NIH HHS / United States
DP2OD002750 / OD / NIH HHS / United States
P01 CA163222 / CA / NCI NIH HHS / United States
P50 CA127003 / CA / NCI NIH HHS / United States
R33 CA155554 / CA / NCI NIH HHS / United States
|