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Shi H, Hong A, Kong X, Koya RC, Song C, Moriceau G, Hugo W, Yu CC, Ng C, Chodon T, Scolyer RA, Kefford RF, Ribas A, Long GV, Lo RS. A novel AKT1 mutant amplifies an adaptive melanoma response to BRAF inhibition. Cancer Discov 2013; 4:69-79. [PMID: 24265152 DOI: 10.1158/2159-8290.cd-13-0279] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BRAF inhibitor (BRAFi) therapy leads to remarkable anti melanoma responses, but the initial tumor shrinkage is commonly incomplete, providing a nidus for subsequent disease progression. Adaptive signaling may underlie early BRAFi resistance and influence the selection pattern for genetic variants, causing late, acquired resistance. We show here that BRAFi (or BRAFi + MEKi) therapy in patients frequently led to rebound phosphorylated AKT (p-AKT) levels in their melanomas early on-treatment. In cell lines, BRAFi treatment led to rebound levels of receptor tyrosine kinases (RTK; including PDGFRβ), phosphatidyl (3,4,5)-triphosphate (PIP3), pleckstrin homology domain recruitment, and p-AKT. PTEN expression limited this BRAFi-elicited PI3K-AKT signaling, which could be rescued by the introduction of a mutant AKT1 (Q79K) known to confer acquired BRAFi resistance. Functionally, AKT1(Q79K) conferred BRAFi resistance via amplification of BRAFi-elicited PI3K-AKT signaling. In addition, mitogen-activated protein kinase pathway inhibition enhanced clonogenic growth dependency on PI3K or AKT. Thus, adaptive or genetic upregulation of AKT critically participates in melanoma survival during BRAFi therapy.
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Affiliation(s)
- Hubing Shi
- 1The Division of Dermatology, Department of Medicine, 2Division of Surgical Oncology, Department of Surgery, 3Division of Hematology and Oncology, Department of Medicine, 4Jonsson Comprehensive Cancer Center, 5Department of Molecular and Medical Pharmacology, 6David Geffen School of Medicine, University of California, Los Angeles, California; 7Melanoma Institute of Australia, 8Royal Prince Alfred Hospital, 9Westmead Millennium Institute, and 10Westmead Hospital, University of Sydney, New South Wales, Australia
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Shi H, Hugo W, Kong X, Hong A, Koya RC, Moriceau G, Chodon T, Guo R, Johnson DB, Dahlman KB, Kelley MC, Kefford RF, Chmielowski B, Glaspy JA, Sosman JA, van Baren N, Long GV, Ribas A, Lo RS. Acquired resistance and clonal evolution in melanoma during BRAF inhibitor therapy. Cancer Discov 2013; 4:80-93. [PMID: 24265155 DOI: 10.1158/2159-8290.cd-13-0642] [Citation(s) in RCA: 750] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BRAF inhibitors elicit rapid antitumor responses in the majority of patients with BRAF(V600)-mutant melanoma, but acquired drug resistance is almost universal. We sought to identify the core resistance pathways and the extent of tumor heterogeneity during disease progression. We show that mitogen-activated protein kinase reactivation mechanisms were detected among 70% of disease-progressive tissues, with RAS mutations, mutant BRAF amplification, and alternative splicing being most common. We also detected PI3K-PTEN-AKT-upregulating genetic alterations among 22% of progressive melanomas. Distinct molecular lesions in both core drug escape pathways were commonly detected concurrently in the same tumor or among multiple tumors from the same patient. Beyond harboring extensively heterogeneous resistance mechanisms, melanoma regrowth emerging from BRAF inhibitor selection displayed branched evolution marked by altered mutational spectra/signatures and increased fitness. Thus, melanoma genomic heterogeneity contributes significantly to BRAF inhibitor treatment failure, implying upfront, cotargeting of two core pathways as an essential strategy for durable responses.
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Affiliation(s)
- Hubing Shi
- Division of Dermatology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Willy Hugo
- Division of Dermatology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Xiangju Kong
- Division of Dermatology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Aayoung Hong
- Division of Dermatology, Department of Medicine.,Department of Molecular and Medical Pharmacology.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Richard C Koya
- Division of Surgical Oncology, Department of Surgery.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Gatien Moriceau
- Division of Dermatology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Thinle Chodon
- Division of Hematology & Oncology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Rongqing Guo
- Division of Hematology & Oncology, Department of Medicine.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Douglas B Johnson
- Department of Medicine.,Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Kimberly B Dahlman
- Department of Cancer Biology.,Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Mark C Kelley
- Department of Surgery.,Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Richard F Kefford
- Melanoma Institute of Australia, Westmead Millenium Institute, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - Bartosz Chmielowski
- Division of Hematology & Oncology, Department of Medicine.,Jonsson Comprehensive Cancer Center.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - John A Glaspy
- Division of Hematology & Oncology, Department of Medicine.,Jonsson Comprehensive Cancer Center.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Jeffrey A Sosman
- Department of Medicine.,Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | | | - Georgina V Long
- Melanoma Institute of Australia, Westmead Millenium Institute, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - Antoni Ribas
- Division of Dermatology, Department of Medicine.,Division of Hematology & Oncology, Department of Medicine.,Jonsson Comprehensive Cancer Center.,Department of Molecular and Medical Pharmacology.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
| | - Roger S Lo
- Division of Dermatology, Department of Medicine.,Jonsson Comprehensive Cancer Center.,Department of Molecular and Medical Pharmacology.,David Geffen School of Medicine, University of California, LA, California 90095-1662 USA
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Menzies AM, Long GV. New combinations and immunotherapies for melanoma: latest evidence and clinical utility. Ther Adv Med Oncol 2013; 5:278-85. [PMID: 23997828 DOI: 10.1177/1758834013499637] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Until recently there was no effective systemic therapy for metastatic melanoma. Increased understanding of tumor biology and immune regulation has led to the development of drugs targeting the mitogen-activated protein kinase (MAPK) pathway (BRAF inhibitors and MEK inhibitors) and T-cell regulation (CTLA4 antibodies). These drugs are the new standard of care, however barriers to better patient outcomes include limited responses and significant toxicities (CTLA4 antibodies) and lack of durability in the majority of cases (BRAF and MEK inhibitors). This review discusses the next stages of development of treatments in melanoma, including immune checkpoint blocking drugs targeting the PD-1/PD-L1 axis, and the use of BRAF and MEK inhibitors in combination. Both approaches lead to a higher proportion of durable responses coupled with less toxicity. In an effort to improve outcomes even further, clinical trials of combinations of MAPK inhibitors, immunotherapies and other signal pathway inhibitors are underway. Adjuvant studies of many of these drugs have commenced, with the hope of also improving outcomes in patients with early-stage melanoma.
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Recent advances in melanoma systemic therapy. BRAF inhibitors, CTLA4 antibodies and beyond. Eur J Cancer 2013; 49:3229-41. [PMID: 23870385 DOI: 10.1016/j.ejca.2013.06.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 01/04/2023]
Abstract
Metastatic melanoma has a poor prognosis and until recently systemic therapy was ineffective. Advances in the understanding of tumour biology and immune regulation have led to the development of targeted agents that have changed clinical practice, with further improvements expected with new compounds and combinations. The first major advance was the development of selective mitogen-activated protein (MAP) kinase inhibitors (BRAF and MEK inhibitors) and immune checkpoint blockade with a CTLA4 antibody (ipilimumab). These drugs proved vastly superior to conventional chemotherapy, however response, resistance and toxicity were limitations. The second major advance is the development of other immune checkpoint blocking agents, including PD-1 and PD-L1 antibodies, and the use of BRAF and MEK inhibitors in combination, with a higher proportion of durable responses coupled with less toxicity. In an effort to improve outcomes for patients with melanoma further, trials are underway examining the combination of MAPK inhibitors, immunotherapies and other pathway inhibitors and adjuvant studies of many of these agents have commenced.
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