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Bravetti GE, Muggler K, Ben Aissa A, Thumann G, Malclès A. Rapid diurnal variation of serous retinal detachment during BRAF and MEK inhibitor treatment: A case series. Acta Ophthalmol 2024; 102:e651-e656. [PMID: 38235944 DOI: 10.1111/aos.16639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Affiliation(s)
| | - Kevin Muggler
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Assma Ben Aissa
- Department of Oncology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine of the University of Geneva, UNIGE, Geneva, Switzerland
| | - Ariane Malclès
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine of the University of Geneva, UNIGE, Geneva, Switzerland
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Algazi AP, Moon J, Lao CD, Chmielowski B, Kendra KL, Lewis KD, Gonzalez R, Kim K, Godwin JE, Curti BD, Latkovic-Taber M, Lomeli SH, Gufford BT, Scumpia PO, Lo RS, Othus M, Ribas A. A phase 1 study of triple-targeted therapy with BRAF, MEK, and AKT inhibitors for patients with BRAF-mutated cancers. Cancer 2024; 130:1784-1796. [PMID: 38261444 DOI: 10.1002/cncr.35200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/30/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aberrant PI3K/AKT signaling in BRAF-mutant cancers contributes to resistance to BRAF inhibitors. The authors examined dual MAPK and PI3K pathway inhibition in patients who had BRAF-mutated solid tumors (ClinicalTrials.gov identifier NCT01902173). METHODS Patients with BRAF V600E/V600K-mutant solid tumors received oral dabrafenib at 150 mg twice daily with dose escalation of oral uprosertib starting at 50 mg daily, or, in the triplet cohorts, with dose escalation of both oral trametinib starting at 1.5 mg daily and oral uprosertib starting at 25 mg daily. Dose-limiting toxicities (DLTs) were assessed within the first 56 days of treatment. Radiographic responses were assessed at 8-week intervals. RESULTS Twenty-seven patients (22 evaluable) were enrolled in parallel doublet and triplet cohorts. No DLTs were observed in the doublet cohorts (N = 7). One patient had a DLT at the maximum administered dose of triplet therapy (dabrafenib 150 mg twice daily and trametinib 2 mg daily plus uprosertib 75 mg daily). Three patients in the doublet cohorts had partial responses (including one who had BRAF inhibitor-resistant melanoma). Two patients in the triplet cohorts had a partial response, and one patient had an unconfirmed partial response. Pharmacokinetic data suggested reduced dabrafenib and dabrafenib metabolite exposure in patients who were also exposed to both trametinib and uprosertib, but not in whose who were exposed to uprosertib without trametinib. CONCLUSIONS Concomitant inhibition of both the MAPK and PI3K-AKT pathways for the treatment of BRAF-mutated cancers was well tolerated, leading to objective responses, but higher level drug-drug interactions affected exposure to dabrafenib and its metabolites.
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Affiliation(s)
- Alain P Algazi
- University of California-San Francisco, San Francisco, California, USA
| | - James Moon
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Southwest Oncology Group Statistical Center, Seattle, Washington, USA
| | | | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Kari L Kendra
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Karl D Lewis
- University of Colorado Comprehensive Cancer Center, Denver, Colorado, USA
| | - Rene Gonzalez
- University of Colorado Comprehensive Cancer Center, Denver, Colorado, USA
| | - Kevin Kim
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | | | | | | | - Shirley H Lomeli
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | | | - Philip O Scumpia
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Roger S Lo
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
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Van Not OJ, van den Eertwegh AJM, Haanen JB, van Rijn RS, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Boers-Sonderen MJ, de Groot JWWB, Hospers GAP, Kapiteijn E, Bloem M, Piersma D, Stevense-den Boer M, Verheijden RJ, van der Veldt AAM, Wouters MWJM, Blokx WAM, Suijkerbuijk KPM. BRAF/MEK inhibitor rechallenge in advanced melanoma patients. Cancer 2024; 130:1673-1683. [PMID: 38198485 DOI: 10.1002/cncr.35178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Effectivity of BRAF(/MEK) inhibitor rechallenge has been described in prior studies. However, structured data are largely lacking. METHODS Data from all advanced melanoma patients treated with BRAFi(/MEKi) rechallenge were retrieved from the Dutch Melanoma Treatment Registry. The authors analyzed objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) for both first treatment and rechallenge. They performed a multivariable logistic regression and a multivariable Cox proportional hazards model to assess factors associated with response and survival. RESULTS The authors included 468 patients in the largest cohort to date who underwent at least two treatment episodes of BRAFi(/MEKi). Following rechallenge, ORR was 43%, median PFS was 4.6 months (95% confidence interval [CI], 4.1-5.2), and median OS was 8.2 months (95% CI, 7.2-9.4). Median PFS after rechallenge for patients who discontinued first BRAFi(/MEKi) treatment due to progression was 3.1 months (95% CI, 2.7-4.0) versus 5.2 months (95% CI, 4.5-5.9) for patients who discontinued treatment for other reasons. Discontinuing first treatment due to progression and lactate dehydrogenase (LDH) levels greater than two times the upper limit of normal were associated with lower odds of response and worse PFS and OS. Symptomatic brain metastases were associated with worse survival, whereas a longer treatment interval between first treatment and rechallenge was associated with better survival. Responding to the first BRAFi(/MEKi) treatment was not associated with response or survival. CONCLUSIONS This study confirms that patients benefit from rechallenge. Elevated LDH levels, symptomatic brain metastases, and discontinuing first BRAFi(/MEKi) treatment due to progression are associated with less benefit from rechallenge. A prolonged treatment interval is associated with more benefit from rechallenge.
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Affiliation(s)
- Olivier J Van Not
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - John B Haanen
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Manja Bloem
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Rik J Verheijden
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Aya F, Lanuza-Gracia P, González-Pérez A, Bonnal S, Mancini E, López-Bigas N, Arance A, Valcárcel J. Genomic deletions explain the generation of alternative BRAF isoforms conferring resistance to MAPK inhibitors in melanoma. Cell Rep 2024; 43:114048. [PMID: 38614086 DOI: 10.1016/j.celrep.2024.114048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
Resistance to MAPK inhibitors (MAPKi), the main cause of relapse in BRAF-mutant melanoma, is associated with the production of alternative BRAF mRNA isoforms (altBRAFs) in up to 30% of patients receiving BRAF inhibitor monotherapy. These altBRAFs have been described as being generated by alternative pre-mRNA splicing, and splicing modulation has been proposed as a therapeutic strategy to overcome resistance. In contrast, we report that altBRAFs are generated through genomic deletions. Using different in vitro models of altBRAF-mediated melanoma resistance, we demonstrate the production of altBRAFs exclusively from the BRAF V600E allele, correlating with corresponding genomic deletions. Genomic deletions are also detected in tumor samples from melanoma and breast cancer patients expressing altBRAFs. Along with the identification of altBRAFs in BRAF wild-type and in MAPKi-naive melanoma samples, our results represent a major shift in our understanding of mechanisms leading to the generation of BRAF transcripts variants associated with resistance in melanoma.
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Affiliation(s)
- Francisco Aya
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Medical Oncology Department, Hospital Clinic, Barcelona, Spain; Institut de Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Lanuza-Gracia
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Abel González-Pérez
- Institute for Research in Biomedicine (IRB), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Sophie Bonnal
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Estefania Mancini
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Nuria López-Bigas
- Institute for Research in Biomedicine (IRB), The Barcelona Institute of Science and Technology, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Ana Arance
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain; Institut de Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Valcárcel
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
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Fareed A, Amir N, Ajaz H, Sohail A, Vaid R, Farhat S. Advances in BRAF-targeted therapies for non-small cell lung cancer: the promise of encorafenib and binimetinib. Int J Surg 2024; 110:1891-1893. [PMID: 38215251 PMCID: PMC11020025 DOI: 10.1097/js9.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College
| | - Nabiha Amir
- Department of Medicine, Karachi Medical and Dental College
| | - Humna Ajaz
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Afra Sohail
- Department of Medicine, Karachi Medical and Dental College
| | - Rayyan Vaid
- Department of Medicine, Karachi Medical and Dental College
| | - Solay Farhat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Colak R, Kapar C, Gulturk I, Yilmaz M. Nivolumab treatment in a patient with BRAF mutant advanced melanoma and liver failure with encephalopathy. J Oncol Pharm Pract 2024; 30:589-593. [PMID: 38111303 DOI: 10.1177/10781552231221230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND We report the case of a patient with melanoma and liver failure with encephalopathy, successfully treated with nivolumab without major side effects and encouraging prolonged disease control. CASE PRESENTATION In June 2022, metastatic lesions appeared in the liver associated with melanoma progression under treatment. Liver biopsy was non-diagnostic. The patient developed fever, abdominal distension, and jaundice. Liver function tests (LFTs) began to deteriorate. Hepatic encephalopathy developed in accordance with the worsening liver functions in the patient. Upper abdominal MRI with primovist showed multiple, progressive, metastatic lesions in the liver and mild to moderate dilatation of the intrahepatic biliary tract. Patient was evaluated as acute cholangitis associated with the compression of the biliary tract by progressive liver metastases. In December 2022, the patient was started antibiotherapy for cholangitis and Nivolumab (240 mg flat dose, every 2 weeks) therapy. After the first dose, both LFT and constitutional symptoms began to improve. Subsequently, LFTs almost completely returned to normal, clinical response was achieved. Multiple metastatic lesions in the liver regressed in the radiological evaluation performed at the third month of nivolumab treatment. With partial response, nivolumab treatment is continued. CONCLUSION In this case is reported patient with hepatic encephalopathy due to an advanced refractory melanome successfully, and safely, treated with programed cell death-1 (PD-1) inhibitors. Clinical trials to explore the benefits of these immunotherapies in the hepatic failure population with advanced solid tumors should be supported.
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Affiliation(s)
- Rumeysa Colak
- Medical Oncology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology Department, Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Caner Kapar
- Medical Oncology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology Department, Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Ilkay Gulturk
- Medical Oncology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology Department, Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Mesut Yilmaz
- Medical Oncology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology Department, Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
- Medical Oncology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Jenkins LJ, Luk IY, Chionh F, Tan T, Needham K, Ayton J, Reehorst CM, Vukelic N, Sieber OM, Mouradov D, Gibbs P, Williams DS, Tebbutt NC, Desai J, Hollande F, Dhillon AS, Lee EF, Merino D, Fairlie WD, Mariadason JM. BCL-X L inhibitors enhance the apoptotic efficacy of BRAF inhibitors in BRAF V600E colorectal cancer. Cell Death Dis 2024; 15:183. [PMID: 38429301 PMCID: PMC10907349 DOI: 10.1038/s41419-024-06478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
Metastatic BRAFV600E colorectal cancer (CRC) carries an extremely poor prognosis and is in urgent need of effective new treatments. While the BRAFV600E inhibitor encorafenib in combination with the EGFR inhibitor cetuximab (Enc+Cet) was recently approved for this indication, overall survival is only increased by 3.6 months and objective responses are observed in only 20% of patients. We have found that a limitation of Enc+Cet treatment is the failure to efficiently induce apoptosis in BRAFV600E CRCs, despite inducing expression of the pro-apoptotic protein BIM and repressing expression of the pro-survival protein MCL-1. Here, we show that BRAFV600E CRCs express high basal levels of the pro-survival proteins MCL-1 and BCL-XL, and that combining encorafenib with a BCL-XL inhibitor significantly enhances apoptosis in BRAFV600E CRC cell lines. This effect was partially dependent on the induction of BIM, as BIM deletion markedly attenuated BRAF plus BCL-XL inhibitor-induced apoptosis. As thrombocytopenia is an established on-target toxicity of BCL-XL inhibition, we also examined the effect of combining encorafenib with the BCL-XL -targeting PROTAC DT2216, and the novel BCL-2/BCL-XL inhibitor dendrimer conjugate AZD0466. Combining encorafenib with DT2216 significantly increased apoptosis induction in vitro, while combining encorafenib with AZD0466 was well tolerated in mice and further reduced growth of BRAFV600E CRC xenografts compared to either agent alone. Collectively, these findings demonstrate that combined BRAF and BCL-XL inhibition significantly enhances apoptosis in pre-clinical models of BRAFV600E CRC and is a combination regimen worthy of clinical investigation to improve outcomes for these patients.
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Affiliation(s)
- Laura J Jenkins
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Ian Y Luk
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Fiona Chionh
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Tao Tan
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Kristen Needham
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Jamieson Ayton
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Camilla M Reehorst
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Natalia Vukelic
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
| | - Oliver M Sieber
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, Australia
| | - Dmitri Mouradov
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter Gibbs
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - David S Williams
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
- Department of Pathology, Austin Health, Melbourne, VIC, Australia
| | - Niall C Tebbutt
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Frédéric Hollande
- Department of Clinical Pathology, The University of Melbourne, Melbourne, VIC, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Amardeep S Dhillon
- The institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Erinna F Lee
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - Delphine Merino
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - W Douglas Fairlie
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - John M Mariadason
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.
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von Fritsch L, von Bubnoff N, Weber K, Kirfel J, Schreiber C, Keck T, Wellner U. Near complete remission of an inoperable pancreatic acinar cell carcinoma after BRAF-/MEK-inhibitor treatment-A case report and review of the literature. Genes Chromosomes Cancer 2024; 63:e23222. [PMID: 38340027 DOI: 10.1002/gcc.23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Pancreatic acinar cell carcinomas are rare malignant neoplasms. High-quality evidence about the best treatment strategy is lacking. We present the case of a 52-year-old male with a BRAFV600E -mutated PACC who experienced a complete remission after chemotherapy with BRAF-/MEK-inhibitors. CASE The patient presented with upper abdomen pain, night sweat, and weight loss. CT scan showed a pancreatic tumor extending from the pancreas head to body. Histological workup identified an acinar cell carcinoma. As the tumor was inoperable, chemotherapy with FOFIRNIOX was initiated and initially showed a slight regression of disease. The regimen had to be discontinued due to severe side effects. Molecular analysis identified a BRAFV600E mutation, so the patient was started on BRAF- and MEK-inhibitors (dabrafenib/trametinib). After 16 months, CT scans showed a near complete remission with a markedly improved overall health. DISCUSSION Studies suggest that up to one-fourth of PACCs carry a BRAF mutation and might therefore be susceptible to a BRAF-/MEK-inhibitor therapy. This offers a new therapeutic pathway to treat this rare but malignant neoplasm.
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Affiliation(s)
- Lennart von Fritsch
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Klaus Weber
- Luebecker Onkologische Schwerpunktpraxis, Lübeck, Germany
| | - Jutta Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Cleopatra Schreiber
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Ulrich Wellner
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
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Sidaway P. BRAF plus MEK inhibition effective in papillary craniopharyngioma. Nat Rev Clin Oncol 2023; 20:661. [PMID: 37491596 DOI: 10.1038/s41571-023-00807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
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10
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Nazir ZH, Haliasos HC, Busam KJ, Marchetti MA, Linos K, Marghoob AA. Acquired Melanocytic Nevi Mimicking Acral Lentiginous Melanoma in a Patient Taking a BRAF Inhibitor. JAMA Dermatol 2023; 159:1147-1149. [PMID: 37672258 DOI: 10.1001/jamadermatol.2023.2669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
This case report describes a patient in their 60s with metastatic colon cancer who developed multiple new dark nevi within 2 months of initiating encorafenib and panitumumab therapy.
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Affiliation(s)
- Zaeem H Nazir
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Helen C Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Myszkiewicz MF, Puzanov I, Goey AKL. Development and validation of an LC-MS/MS method to measure the BRAF inhibitors dabrafenib and encorafenib quantitatively and four major metabolites semi-quantitatively in human plasma. J Pharm Biomed Anal 2023; 234:115594. [PMID: 37478552 PMCID: PMC10528671 DOI: 10.1016/j.jpba.2023.115594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
This article describes the development and validation of a liquid-chromatography coupled with tandem mass spectrometry (LC-MS/MS) assay for the simultaneous quantitation of the BRAF inhibitors dabrafenib and encorafenib, and semi-quantitation of their major metabolites (i.e., carboxy-dabrafenib, desmethyl-dabrafenib, hydroxy-dabrafenib, M42.5A) in human plasma. Analytes were extracted from human plasma by protein precipitation, followed by reversed phase high-performance liquid chromatography. Analyte detection was performed using tandem mass spectrometry with heated electrospray ionization operating in positive ion mode. The assay was validated in accordance with the current U.S. Food and Drug Administration Guidance on Bioanalytical Method Validation. Results showed that measurements were both accurate (94.6-112.0 %) and precise (within-run: 1.9-3.4 %; between-run: 1.7-12.0 %) spanning a concentration range of 5 to 2000 ng/mL for dabrafenib and 10 to 4000 ng/mL for encorafenib. Recoveries for these analytes were consistent with mean values ranging from 85.6 % to 90.9 %. The mean internal standard-normalized matrix factors for each drug ranged between 0.87 and 0.98 and were found to be precise (% RSD <6.4 %). Dabrafenib and encorafenib were stable in the final extract and in human plasma held under various storage conditions. The metabolites also passed the validation criteria for precision and selectivity. Finally, the clinical applicability of the assay was confirmed by (semi-)quantitation of all six analytes in plasma samples from cancer patients receiving standard-of-care treatment with dabrafenib and encorafenib. Reproducibility of the measured analyte concentrations in study samples was confirmed successfully by incurred sample reanalysis. In conclusion, this sensitive LC-MS/MS assay has been validated successfully and is suitable for therapeutic drug monitoring of dabrafenib and encorafenib and clinical pharmacokinetic studies with these BRAF inhibitors.
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Affiliation(s)
- Melody F Myszkiewicz
- Bioanalytics, Metabolomics, and Pharmacokinetics Shared Resource, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Andrew K L Goey
- Bioanalytics, Metabolomics, and Pharmacokinetics Shared Resource, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Brastianos PK, Twohy E, Geyer S, Gerstner ER, Kaufmann TJ, Tabrizi S, Kabat B, Thierauf J, Ruff MW, Bota DA, Reardon DA, Cohen AL, De La Fuente MI, Lesser GJ, Campian J, Agarwalla PK, Kumthekar P, Mann B, Vora S, Knopp M, Iafrate AJ, Curry WT, Cahill DP, Shih HA, Brown PD, Santagata S, Barker FG, Galanis E. BRAF-MEK Inhibition in Newly Diagnosed Papillary Craniopharyngiomas. N Engl J Med 2023; 389:118-126. [PMID: 37437144 PMCID: PMC10464854 DOI: 10.1056/nejmoa2213329] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Craniopharyngiomas, primary brain tumors of the pituitary-hypothalamic axis, can cause clinically significant sequelae. Treatment with the use of surgery, radiation, or both is often associated with substantial morbidity related to vision loss, neuroendocrine dysfunction, and memory loss. Genotyping has shown that more than 90% of papillary craniopharyngiomas carry BRAF V600E mutations, but data are lacking with regard to the safety and efficacy of BRAF-MEK inhibition in patients with papillary craniopharyngiomas who have not undergone previous radiation therapy. METHODS Eligible patients who had papillary craniopharyngiomas that tested positive for BRAF mutations, had not undergone radiation therapy previously, and had measurable disease received the BRAF-MEK inhibitor combination vemurafenib-cobimetinib in 28-day cycles. The primary end point of this single-group, phase 2 study was objective response at 4 months as determined with the use of centrally determined volumetric data. RESULTS Of the 16 patients in the study, 15 (94%; 95% confidence interval [CI], 70 to 100) had a durable objective partial response or better to therapy. The median reduction in the volume of the tumor was 91% (range, 68 to 99). The median follow-up was 22 months (95% CI, 19 to 30) and the median number of treatment cycles was 8. Progression-free survival was 87% (95% CI, 57 to 98) at 12 months and 58% (95% CI, 10 to 89) at 24 months. Three patients had disease progression during follow-up after therapy had been discontinued; none have died. The sole patient who did not have a response stopped treatment after 8 days owing to toxic effects. Grade 3 adverse events that were at least possibly related to treatment occurred in 12 patients, including rash in 6 patients. In 2 patients, grade 4 adverse events (hyperglycemia in 1 patient and increased creatine kinase levels in 1 patient) were reported; 3 patients discontinued treatment owing to adverse events. CONCLUSIONS In this small, single-group study involving patients with papillary craniopharyngiomas, 15 of 16 patients had a partial response or better to the BRAF-MEK inhibitor combination vemurafenib-cobimetinib. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT03224767.).
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Affiliation(s)
- Priscilla K Brastianos
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Erin Twohy
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Susan Geyer
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Elizabeth R Gerstner
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Timothy J Kaufmann
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Shervin Tabrizi
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Brian Kabat
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Julia Thierauf
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Michael W Ruff
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Daniela A Bota
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - David A Reardon
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Adam L Cohen
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Macarena I De La Fuente
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Glenn J Lesser
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Jian Campian
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Pankaj K Agarwalla
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Priya Kumthekar
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Bhupinder Mann
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Shivangi Vora
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Michael Knopp
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - A John Iafrate
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - William T Curry
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Daniel P Cahill
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Helen A Shih
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Paul D Brown
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Sandro Santagata
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Fred G Barker
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
| | - Evanthia Galanis
- From Massachusetts General Hospital Cancer Center, Harvard Medical School (P.K.B., E.R.G., S.T., J.T., A.J.I., W.T.C., D.P.C., H.A.S., F.G.B.), Dana-Farber Cancer Institute (D.A.R.), and Brigham and Women's Hospital, Harvard Program in Therapeutic Science, Dana-Farber Partners CancerCare (S.S.) - all in Boston; Alliance Statistics and Data Management Center (E.T., S.G., B.K.), Mayo Clinic (T.J.K., M.W.R., P.D.B., E.G.), Rochester, MN; UC Irvine-Chao Family Comprehensive Cancer Center, Orange, CA (D.A.B.); Huntsman Cancer Institute, University of Utah, Salt Lake City (A.L.C.); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami (M.I.D.L.F.); Wake Forest University School of Medicine, Winston-Salem, NC (G.J.L.); Washington University School of Medicine, St. Louis (J.C.); Rutgers Cancer Institute, New Brunswick, NJ (P.K.A.); Northwestern University, Chicago (P.K.); the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (B.M.); and Ohio State University Comprehensive Cancer Center, Columbus (S.V., M.K.)
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13
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Lagoutte-Renosi J, Karsenty J, Martha B, Davani S, Muret P. Management of a drug-drug interaction between BRAF inhibitors and combined antiretroviral therapy in a HIV-infected patient with craniopharyngioma. AIDS 2023; 37:1181-1183. [PMID: 37139656 DOI: 10.1097/qad.0000000000003527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Jennifer Lagoutte-Renosi
- EA 3920 Université de Franche-Comté
- Service de Pharmacologie Clinique et Toxicologie, CHU de Besançon, Besançon
| | - Judith Karsenty
- Service de maladies infectieuses, Centre Hospitalier William Morey, Chalon sur Saône, France
| | - Benoît Martha
- Service de maladies infectieuses, Centre Hospitalier William Morey, Chalon sur Saône, France
| | - Siamak Davani
- EA 3920 Université de Franche-Comté
- Service de Pharmacologie Clinique et Toxicologie, CHU de Besançon, Besançon
| | - Patrice Muret
- Service de Pharmacologie Clinique et Toxicologie, CHU de Besançon, Besançon
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14
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Al-Wahaibi LH, Abou-Zied HA, Beshr EAM, Youssif BGM, Hayallah AM, Abdel-Aziz M. Design, Synthesis, Antiproliferative Actions, and DFT Studies of New Bis-Pyrazoline Derivatives as Dual EGFR/BRAF V600E Inhibitors. Int J Mol Sci 2023; 24:9104. [PMID: 37240450 PMCID: PMC10218941 DOI: 10.3390/ijms24109104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Some new Bis-pyrazoline hybrids 8-17 with dual EGFR and BRAFV600E inhibitors have been developed. The target compounds were synthesized and tested in vitro against four cancer cell lines. Compounds 12, 15, and 17 demonstrated strong antiproliferative activity with GI50 values of 1.05 µM, 1.50 µM, and 1.20 µM, respectively. Hybrids showed dual inhibition of EGFR and BRAFV600E. Compounds 12, 15, and 17 inhibited EGFR-like erlotinib and exhibited promising anticancer activity. Compound 12 is the most potent inhibitor of cancer cell proliferation and BRAFV600E. Compounds 12 and 17 induced apoptosis by increasing caspase 3, 8, and Bax levels, and resulted in the downregulation of the antiapoptotic Bcl2. The molecular docking studies verified that compounds 12, 15, and 17 have the potential to be dual EGFR/BRAFV600E inhibitors. Additionally, in silico ADMET prediction revealed that most synthesized bis-pyrazoline hybrids have low toxicity and adverse effects. DFT studies for the two most active compounds, 12 and 15, were also carried out. The values of the HOMO and LUMO energies, as well as softness and hardness, were computationally investigated using the DFT method. These findings agreed well with those of the in vitro research and molecular docking study.
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Affiliation(s)
- Lamya H. Al-Wahaibi
- Department of Chemistry, College of Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia;
| | - Hesham A. Abou-Zied
- Medicinal Chemistry Department, Faculty of Pharmacy, Deraya University, Minia 61111, Egypt; (H.A.A.-Z.); (M.A.-A.)
| | - Eman A. M. Beshr
- Medicinal Chemistry Department, Faculty of Pharmacy, Minia University, Minia 61519, Egypt;
| | - Bahaa G. M. Youssif
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Alaa M. Hayallah
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Sphinx University, Assiut 71515, Egypt
| | - Mohamed Abdel-Aziz
- Medicinal Chemistry Department, Faculty of Pharmacy, Deraya University, Minia 61111, Egypt; (H.A.A.-Z.); (M.A.-A.)
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15
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Alamri AM, Alkhilaiwi FA, Khan NU, Tasleem M. In silico Screening and Validation of Achyranthes aspera as a Potential Inhibitor of BRAF and NRAS in Controlling Thyroid Cancer. Anticancer Agents Med Chem 2023; 23:2111-2126. [PMID: 37287303 DOI: 10.2174/1871520623666230607125258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Thyroid carcinoma (THCA) is one of the most prevalent endocrine tumors, accounting for 3.4% of all cancers diagnosed annually. Single Nucleotide Polymorphisms (SNPs) are the most prevalent genetic variation associated with thyroid cancer. Understanding thyroid cancer genetics will enhance diagnosis, prognosis, and treatment. METHODS This TCGA-based study analyzes thyroid cancer-associated highly mutated genes through highly robust in silico techniques. Pathway, gene expression, and survival studies were performed on the top 10 highly mutated genes (BRAF, NRAS, TG, TTN, HRAS, MUC16, ZFHX3, CSMD2, EIFIAX, SPTA1). Novel natural compounds from Achyranthes aspera Linn were discovered to target two highly mutated genes. The natural compounds and synthetic drugs used to treat thyroid cancer were subjected to comparative molecular docking against BRAF and NRAS targets. The ADME characteristics of Achyranthes aspera Linn compounds were also investigated. RESULTS The gene expression analysis revealed that the expression of ZFHX3, MCU16, EIF1AX, HRAS, and NRAS was up-regulated in tumor cells while BRAF, TTN, TG, CSMD2, and SPTA1 were down-regulated in tumor cells. In addition, the protein-protein interaction network demonstrated that HRAS, BRAF, NRAS, SPTA1, and TG proteins have strong interactions with each other as compared to other genes. The ADMET analysis shows that seven compounds have druglike properties. These compounds were further studied for molecular docking studies. The compounds MPHY012847, IMPHY005295, and IMPHY000939 show higher binding affinity with BRAF than pimasertib. In addition, IMPHY000939, IMPHY000303, IMPHY012847, and IMPHY005295 showed a better binding affinity with NRAS than Guanosine Triphosphate. CONCLUSION The outcomes of docking experiments conducted on BRAF and NRAS provide insight into natural compounds with pharmacological characteristics. These findings indicate that natural compounds derived from plants as a more promising cancer treatment option. Thus, the results of docking investigations conducted on BRAF and NRAS substantiate the conclusions that the molecule possesses the most suited drug-like qualities. Compared to other compounds, natural compounds are superior, and they are also druggable. This demonstrates that natural plant compounds can be an excellent source of potential anti-cancer agents. The preclinical research will pave the road for a possible anti-cancer agent.
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Affiliation(s)
- Ahmad M Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61413, Saudi Arabia
- Cancer Research Unit, King Khalid University, Abha, 61413, Saudi Arabia
| | - Faris A Alkhilaiwi
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Regenerative Medicine Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Najeeb U Khan
- Institute of Biotechnology and Genetic Engineering (Health Division), The University of Agriculture Peshawar, Peshawar, 25130, Pakistan
| | - Munazzah Tasleem
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
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16
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Pires da Silva I, Zakria D, Ahmed T, Trojanello C, Dimitriou F, Allayous C, Gerard C, Zimmer L, Lo S, Michielin O, Lebbe C, Mangana J, Ascierto PA, Johnson DB, Carlino M, Menzies A, Long G. Efficacy and safety of anti-PD1 monotherapy or in combination with ipilimumab after BRAF/MEK inhibitors in patients with BRAF mutant metastatic melanoma. J Immunother Cancer 2022; 10:e004610. [PMID: 35798536 PMCID: PMC9263926 DOI: 10.1136/jitc-2022-004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with V600BRAF mutant metastatic melanoma have higher rates of progression-free survival (PFS) and overall survival (OS) with first-line anti-PD1 (PD1]+anti-CTLA-4 (IPI) versus PD1. Whether this is also true after BRAF/MEKi therapy is unknown. We aimed to determine the efficacy and safety of PD1 versus IPI +PD1 after BRAF/MEK inhibitors (BRAF/MEKi). METHODS Patients with V600BRAF mutant metastatic melanoma treated with BRAF/MEKi who had subsequent PD1 versus IPI+PD1 at eight centers were included. The endpoints were objective response rate (ORR), PFS, OS and safety in each group. RESULTS Of 200 patients with V600E (75%) or non-V600E (25%) mutant metastatic melanoma treated with BRAF/MEKi (median time of treatment 7.6 months; treatment cessation due to progressive disease in 77%), 115 (57.5%) had subsequent PD1 and 85 (42.5%) had IPI+PD1. Differences in patient characteristics between PD1 and IPI+PD1 groups included, age (med. 63 vs 54 years), time between BRAF/MEKi and PD1±IPI (16 vs 4 days), Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≥1 (62% vs 44%), AJCC M1C/M1D stage (72% vs 94%) and progressing brain metastases at the start of PD1±IPI (34% vs 57%). Median follow-up from PD1±IPI start was 37.8 months (95% CI, 33.9 to 52.9). ORR was 36%; 34% with PD1 vs 39% with IPI+PD1 (p=0.5713). Median PFS was 3.4 months; 3.4 with PD1 vs 3.6 months with IPI+PD1 (p=0.6951). Median OS was 15.4 months; 14.4 for PD1 vs 20.5 months with IPI+PD1 (p=0.2603). The rate of grade 3 or 4 toxicities was higher with IPI+PD1 (31%) vs PD1 (7%). ORR, PFS and OS were numerically higher with IPI+PD1 vs PD1 across most subgroups except for females, those with <10 days between BRAF/MEKi and PD1±IPI, and those with stage III/M1A/M1B melanoma. The combination of ECOG PS=0 and absence of liver metastases identified patients with >3 years OS (area under the curve, AUC=0.74), while ECOG PS ≥1, progressing brain metastases and presence of bone metastases predicted primary progression (AUC=0.67). CONCLUSIONS IPI+PD1 and PD1 after BRAF/MEKi have similar outcomes despite worse baseline prognostic features in the IPI+PD1 group, however, IPI+PD1 is more toxic. A combination of clinical factors can identify long-term survivors, but less accurately those with primary resistance to immunotherapy after targeted therapy.
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Affiliation(s)
- Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Danny Zakria
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Clara Allayous
- Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | | | - Celeste Lebbe
- Université Paris Cite, Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | - Johanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Matteo Carlino
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Georgina Long
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
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17
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Resistance to BRAF/MEK Inhibition in Melanoma Is Mediated by the Androgen Receptor. Cancer Discov 2022;:OF1. [PMID: 35748587 DOI: 10.1158/2159-8290.CD-RW2022-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Androgen receptor (AR) expression increases upon BRAF/MEK inhibitor treatment, promoting resistance.
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18
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Czirbesz K, Pánczél G, Baranyai F, Kispál M, Tóth E, Bőcs K, Balatoni T, Fröhlich G, Liszkay G. [BRAF-MEK inhibitor therapy in melanoma]. Magy Onkol 2022; 66:110-117. [PMID: 35724387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
We investigated the efficacy and safety of vemurafenib+cobimetinib (V+C) and dabrafenib+trametinib (D+T) based on real-life data. From 2015 and 2018 we have selected 118 BRAF-mutated metastatic melanoma patients, treated with V+C and D+T in our institute. We retrospectively analyzed the overall response rate (ORR), the progression-free survival (PFS), the overall survival (OS) and the adverse events of the therapies. The median follow-up time was 18 months (3-43) with V+C and 12 months (3-43) with D+T. The median PFS was 8 months in the V+C and 8.5 months in the D+T group. Median OS was 18 months in V+C group and 12 months with D+T. The ORR was revealed to be 82% in D+T group and 76% in V+C group. Each combination displayed a slightly different safety profile. In our retrospective analysis both BRAF-MEK inhibitor combination therapies showed favorable efficacy with a slightly different spectrum of toxicity profile.
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Affiliation(s)
- Kata Czirbesz
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Gitta Pánczél
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Fanni Baranyai
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Mihály Kispál
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Erika Tóth
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary
| | - Katalin Bőcs
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary
| | - Tímea Balatoni
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Georgina Fröhlich
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary
| | - Gabriella Liszkay
- Onkodermatológai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
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19
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Oláh J. [mmunotherapy of cutaneous melanoma - update 2022]. Magy Onkol 2022; 66:119-124. [PMID: 35724388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Melanoma treatment has been revolutionized during the last decade. Currently first line therapeutic options for advanced melanoma include immunotherapy with anti-PD-1 antibodies (combination of PD-1 and CTLA-4 blockers should be an option in a selected group of patients) or targeted therapy with BRAF and MEK inhibitors in BRAF V600 mutated tumors. This review aims to summarize long-term survival data of immunotherapy in cutaneous melanoma and to show possible directions of development in combined oncological modalities.
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Affiliation(s)
- Judit Oláh
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Bőrgyógyászati és Allergológiai Klinika, Szeged, Hungary.
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20
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Li Y, Li D, Liu Y, Wang S, Sun M, Zhang Z, Zheng X, Li J, Li Y. The positive feedback loop of NHE1-ERK phosphorylation mediated by BRAF V600E mutation contributes to tumorigenesis and development of glioblastoma. Biochem Biophys Res Commun 2022; 588:1-7. [PMID: 34933181 DOI: 10.1016/j.bbrc.2021.11.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/30/2021] [Indexed: 01/13/2023]
Abstract
The v-raf murine sarcoma viral oncogene homolog B1 (BRAF) activating mutation V600E (BRAFV600E) is involved in glioblastoma multiforme (GBM). Na/H exchanger 1 (NHE1), a main pH regulator affecting cell microenvironment, is hyper-expressed in GBM. However, the relationship between BRAFV600E signal pathway and NHE1 in GMB cells remains unclear. This study found that NHE1 was a downstream target of BRAFV600E and an upstream factor of extracellular signal-regulated kinase (ERK). In addition, there was a positive feedback loop between NHE1-ERK phosphorylation under regulation of BRAFV600E mutation contributing to the proliferation and invasion of GBM cells. Moreover, the proliferation and invasion abilities of BRAFV600E-mutant and BRAF wild type GBM cells were all suppressed by the NHE1 inhibitor, BRAFV600E inhibitor and combination of them. The inhibitory effect of combination of the two inhibitors was better than each single drug both in vitro and in vivo. Combination of BRAFV600E and NHE1 inhibitors could be considered as a new therapeutic regimen for GBM, especially for GBM with BRAFV600E.
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Affiliation(s)
- Yuhui Li
- Department of Neurosurgery, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China
| | - Dan Li
- The Cancer Institute, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China
| | - Yankun Liu
- The Cancer Institute, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China
| | - Shuqing Wang
- Hospital of North China University of Science and Technology, Tangshan, Hebei, 063210, PR China
| | - Mingyang Sun
- Department of Neurosurgery, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China
| | - Zhongyuan Zhang
- Department of Neurosurgery, Zunhua People's Hospital, Zunhua, Hebei, 064200, PR China
| | - Xuan Zheng
- Nuclear Medicine Clinical Laboratory, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China
| | - Jingwu Li
- The Cancer Institute, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China.
| | - Yufeng Li
- The Cancer Institute, Tangshan People's Hospital, Tangshan, Hebei, 063001, PR China.
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21
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Misek SA, Newbury PA, Chekalin E, Paithankar S, Doseff AI, Chen B, Gallo KA, Neubig RR. Ibrutinib Blocks YAP1 Activation and Reverses BRAF Inhibitor Resistance in Melanoma Cells. Mol Pharmacol 2022; 101:1-12. [PMID: 34732527 PMCID: PMC11037454 DOI: 10.1124/molpharm.121.000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/01/2021] [Indexed: 11/22/2022] Open
Abstract
Most B-Raf proto-oncogene (BRAF)-mutant melanoma tumors respond initially to BRAF inhibitor (BRAFi)/mitogen-activated protein kinase kinase 1 inhibitor (MEKi) therapy, although few patients have durable long-term responses to these agents. The goal of this study was to use an unbiased computational approach to identify inhibitors that reverse an experimentally derived BRAFi resistance gene expression signature. Using this approach, we found that ibrutinib effectively reverses this signature, and we demonstrate experimentally that ibrutinib resensitizes a subset of BRAFi-resistant melanoma cells to vemurafenib. Ibrutinib is used clinically as an inhibitor of the Src family kinase Bruton tyrosine kinase (BTK); however, neither BTK deletion nor treatment with acalabrutinib, another BTK inhibitor with reduced off-target activity, resensitized cells to vemurafenib. These data suggest that ibrutinib acts through a BTK-independent mechanism in vemurafenib resensitization. To better understand this mechanism, we analyzed the transcriptional profile of ibrutinib-treated BRAFi-resistant melanoma cells and found that the transcriptional profile of ibrutinib was highly similar to that of multiple Src proto-oncogene kinase inhibitors. Since ibrutinib, but not acalabrutinib, has appreciable off-target activity against multiple Src family kinases, it suggests that ibrutinib may be acting through this mechanism. Furthermore, genes that are differentially expressed in ibrutinib-treated cells are enriched in Yes1-associated transcriptional regulator (YAP1) target genes, and we showed that ibrutinib, but not acalabrutinib, reduces YAP1 activity in BRAFi-resistant melanoma cells. Taken together, these data suggest that ibrutinib, or other Src family kinase inhibitors, may be useful for treating some BRAFi/MEKi-refractory melanoma tumors. SIGNIFICANCE STATEMENT: MAPK-targeted therapies provide dramatic initial responses, but resistance develops rapidly; a subset of these tumors may be rendered sensitive again by treatment with an approved Src family kinase inhibitor-ibrutinub-potentially providing improved clinical outcomes.
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Affiliation(s)
- Sean A Misek
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Patrick A Newbury
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Evgenii Chekalin
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Shreya Paithankar
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Andrea I Doseff
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Bin Chen
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Kathleen A Gallo
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
| | - Richard R Neubig
- Departments of Physiology (S.A.M., A.I.D., K.A.G.), Pediatrics and Human Development (P.A.N., E.C., S.P., B.C.), and Pharmacology (A.I.D., B.C., R.R.N.), Michigan State University, East Lansing, Michigan
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22
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Lee M, Untch BR, Xu B, Ghossein R, Han C, Kuo F, Valero C, Nadeem Z, Patel N, Makarov V, Dogan S, Wong RJ, Sherman EJ, Ho AL, Chan TA, Fagin JA, Morris LGT. Genomic and Transcriptomic Correlates of Thyroid Carcinoma Evolution after BRAF Inhibitor Therapy. Mol Cancer Res 2022; 20:45-55. [PMID: 34635506 PMCID: PMC8738128 DOI: 10.1158/1541-7786.mcr-21-0442] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
Targeted inhibition of BRAF V600E achieves tumor control in a subset of advanced thyroid tumors. Nearly all tumors develop resistance, and some have been observed to subsequently undergo dedifferentiation. The molecular alterations associated with thyroid cancer dedifferentiation in the setting of BRAF inhibition are unknown. We analyzed targeted next-generation sequencing data from 639 advanced, recurrent and/or metastatic thyroid carcinomas, including 15 tumors that were treated with BRAF inhibitor drugs and had tissue sampled during or posttreatment, 8 of which had matched pretherapy samples. Pre- and posttherapy tissues from one additional patient were profiled with whole-exome sequencing and RNA expression profiling. Mutations in genes comprising the SWI/SNF chromatin remodeling complex and the PI3K-AKT-mTOR, MAPK, and JAK-STAT pathways all increased in prevalence across more dedifferentiated thyroid cancer histologies. Of 7 thyroid cancers that dedifferentiated after BRAF inhibition, 6 had mutations in these pathways. These mutations were mostly absent from matched pretreatment samples and were rarely detected in tumors that did not dedifferentiate. Additional analyses in one of the vemurafenib-treated tumors before and after anaplastic transformation revealed the emergence of an oncogenic PIK3CA mutation, activation of ERK signaling, dedifferentiation, and development of an immunosuppressive tumor microenvironment. These findings validate earlier preclinical data implicating these genetic pathways in resistance to BRAF inhibitors, and suggest that genetic alterations mediating acquired drug resistance may also promote thyroid tumor dedifferentiation. IMPLICATIONS: The possibility that thyroid cancer dedifferentiation may be attributed to selective pressure applied by BRAF inhibitor-targeted therapy should be investigated further.
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Affiliation(s)
- Mark Lee
- Weill Cornell Medicine, New York, New York
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Han
- Weill Cornell Medicine, New York, New York
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fengshen Kuo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina Valero
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zaineb Nadeem
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neal Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vladimir Makarov
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy A Chan
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, Ohio
| | - James A Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Yeh JH, Tsai HL, Chen YC, Li CC, Huang CW, Chang TK, Su WC, Chen PJ, Liu YP, Wang JY. BRAF, MEK, and EGFR Triplet Inhibitors as Salvage Therapy in BRAF-Mutated Metastatic Colorectal Cancer-A Case Series Study Target Therapy of BRAF- Mutated mCRC. Medicina (Kaunas) 2021; 57:1339. [PMID: 34946284 PMCID: PMC8707783 DOI: 10.3390/medicina57121339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 01/01/2023]
Abstract
Backgroundand objectives: Patients with BRAF-mutated metastatic colorectal cancer have considerably poorer responses to conventional systemic treatment. The real-world effects of triplet therapy with BRAF, mitogen-activated protein kinase kinase, and epidermal growth factor receptor inhibitors in Asia have not been well-reported. Materials and Methods: This single-center case series included patients with BRAF-mutated metastatic colorectal cancer undergoing triplet therapy after failure of prior systemic treatment from 2016 to 2020. The primary outcome was progression-free survival, and secondary outcomes were overall survival, response rate, disease control rate, and adverse events. Results: Nine eligible patients with BRAF-mutated metastatic colorectal cancer receiving triplet therapy were enrolled, with a median follow-up time of 14.5 months (range, 1-26). Most patients (88.8%) had two or more prior systemic treatments, and the triplet regimen was mainly dabrafenib, trametinib, and panitumumab. The overall response rate and disease control rate were 11.1% and 33.3%, respectively. Median progression-free survival and overall survival were 2.9 and 7.4 months, respectively, and a trend toward better overall survival was found with left-sided metastatic colorectal cancer compared with right-sided disease (9.2 vs. 6.9 months, p = 0.093). Adverse events were mostly Grade 1-2, including nausea, hypertension, gastrointestinal symptoms, and skin disorders. Conclusions: In this single-center case series, triplet therapy with BRAF, mitogen-activated protein kinase kinase, and epidermal growth factor receptor inhibitors in BRAF-mutated metastatic colorectal cancer had an acceptable safety profile and reasonable efficacy.
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Grants
- KMUH109-9R32, KMUH109-9R33, KMUH109-9R34, KMUH109-9M30, KMUH109-9M31, KMUH109-9M32, KMUH109-9M33, KMUHSA10903, KMUHSA11013, KMUH-DK(C)110010, KMUH-DK(B)110004-3 Kaohsiung Medical University Chung-Ho Memorial Hospital
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Affiliation(s)
- Jen-Hao Yeh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.Y.); (Y.-P.L.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung 80794, Taiwan
- Department of Medical technology, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung 82445, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
| | - Ching-Chun Li
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.Y.); (Y.-P.L.)
| | - Jaw-Yuan Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-H.Y.); (Y.-P.L.)
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-L.T.); (Y.-C.C.); (C.-C.L.); (C.-W.H.); (T.-K.C.); (W.-C.S.); (P.-J.C.)
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Liquid biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Pingtung Hospital, Ministry of Health and Welfare, Pingtung 90054, Taiwan
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24
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Al Shahrani M, Abohassan M, Y Alshahrani M, Hakami AR, Rajagopalan P. High-throughput virtual screening and preclinical analysis identifies CB-1, a novel potent dual B-Raf/c-Raf inhibitor, effective against wild and mutant variants of B-Raf expression in colorectal carcinoma. J Comput Aided Mol Des 2021; 35:1165-1176. [PMID: 34727304 DOI: 10.1007/s10822-021-00426-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/20/2021] [Indexed: 01/07/2023]
Abstract
Paradoxical Raf activation via Raf dimerization is a major drawback of wild/mutant B-Raf inhibitors. Herein, we report that CB-1 a novel, potent B-Raf/c-Raf dual inhibitor, effective against colon cancer cells, irrespective of their genetic status. High-throughput virtual screening of the ChemBridge library against wild B-Raf (B-RafWT), mutant B-Raf (B-RafV600E), and c-Raf was performed using an automated protocol with the AutoDock-VINA. Caco-2 and HT-29 cells were used. Of the 23,365 compounds screened computationally, CB-1 showed the highest binding energy towards B-RafWT with a ΔGbinding score of - 13.0 kcal/mol. The compound was also predicted to be effective against B-RafV600E and c-Raf molecules with ΔGbinding energies of - 10.6 and - 10.1 kcal/mol, respectively. The compound inhibited B-RafWT, B-RafV600E and c-Raf kinases with IC50 values of 27.13, 51.70, and 40.23 nM, respectively. The GI50 value of CB-1 was 247.9 nM in B-RafWT-expressing Caco-2 cells and 352.4 nM in B-RafV600E-expressing HT-29 cells. Dose-dependent increases in total apoptosis and G1 cell cycle phase arrest was observed in CB-1-treated colon cancer cells. The compound decreased B-Raf expression in both wild and mutant colon cancer cells. CB-1, a novel, potent dual B-Raf/c-Raf inhibitor was effective against colon cancer cells bearing wild-type and mutant variants of B-Raf expression.
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Affiliation(s)
- Mesfer Al Shahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Central Research Laboratory, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammad Abohassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammad Y Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Abdulrahim R Hakami
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Prasanna Rajagopalan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
- Central Research Laboratory, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
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25
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Abstract
OPINION STATEMENT Molecular heterogeneity has confounded attempts to target individual pathways in brain tumors. However, gliomas with BRAF mutations have been identified as being uniquely vulnerable to targeted therapies. Such mutations are predominantly seen in brain tumors of the adolescent and young adult population. Given that accurate and timely identification of such mutations is essential for offering appropriate treatment, treatment centers should offer both immunohistochemical and sequencing methods for detection of these mutations to guide treatment. Additional studies of these tumors at recurrence would also allow identification of breakthrough resistance mechanisms that may also be targetable for treatment. Due to the relative rarity of these tumors, multicenter collaborative studies will be essential in achieving long term control of these tumors.
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Affiliation(s)
- Appaji Rayi
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Iyad Alnahhas
- Division of Neuro-Oncology, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shirley Ong
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pierre Giglio
- Division of Neuro-Oncology, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA.
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26
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Nassar KW, Hintzsche JD, Bagby SM, Espinoza V, Langouët-Astrié C, Amato CM, Chimed TS, Fujita M, Robinson W, Tan AC, Schweppe RE. Targeting CDK4/6 Represents a Therapeutic Vulnerability in Acquired BRAF/MEK Inhibitor-Resistant Melanoma. Mol Cancer Ther 2021; 20:2049-2060. [PMID: 34376578 PMCID: PMC9768695 DOI: 10.1158/1535-7163.mct-20-1126] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
There is a clear need to identify targetable drivers of resistance and potential biomarkers for salvage therapy for patients with melanoma refractory to the combination of BRAF and MEK inhibition. In this study, we performed whole-exome sequencing on BRAF-V600E-mutant melanoma patient tumors refractory to the combination of BRAF/MEK inhibition and identified acquired oncogenic mutations in NRAS and loss of the tumor suppressor gene CDKN2A We hypothesized the acquired resistance mechanisms to BRAF/MEK inhibition were reactivation of the MAPK pathway and activation of the cell-cycle pathway, which can both be targeted pharmacologically with the combination of a MEK inhibitor (trametinib) and a CDK4/6 inhibitor (palbociclib). In vivo, we found that combination of CDK4/6 and MEK inhibition significantly decreased tumor growth in two BRAF/MEK inhibitor-resistant patient-derived xenograft models. In vitro, we observed that the combination of CDK4/6 and MEK inhibition resulted in synergy and significantly reduced cellular growth, promoted cell-cycle arrest, and effectively inhibited downstream signaling of MAPK and cell-cycle pathways in BRAF inhibitor-resistant cell lines. Knockdown of CDKN2A in BRAF inhibitor-resistant cells increased sensitivity to CDK4/6 inhibition alone and in combination with MEK inhibition. A key implication of our study is that the combination of CDK4/6 and MEK inhibitors overcomes acquired resistance to BRAF/MEK inhibitors, and loss of CDKN2A may represent a biomarker of response to the combination. Inhibition of the cell-cycle and MAPK pathway represents a promising strategy for patients with metastatic melanoma who are refractory to BRAF/MEK inhibitor therapy.
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Affiliation(s)
- Kelsey W Nassar
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer D Hintzsche
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stacey M Bagby
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Veronica Espinoza
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christophe Langouët-Astrié
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carol M Amato
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tugs-Saikhan Chimed
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mayumi Fujita
- Department of Dermatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William Robinson
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Aik Choon Tan
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida.
| | - Rebecca E Schweppe
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Jung T, Haist M, Kuske M, Grabbe S, Bros M. Immunomodulatory Properties of BRAF and MEK Inhibitors Used for Melanoma Therapy-Paradoxical ERK Activation and Beyond. Int J Mol Sci 2021; 22:ijms22189890. [PMID: 34576054 PMCID: PMC8469254 DOI: 10.3390/ijms22189890] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
The advent of mitogen-activated protein kinase (MAPK) inhibitors that directly inhibit tumor growth and of immune checkpoint inhibitors (ICI) that boost effector T cell responses have strongly improved the treatment of metastatic melanoma. In about half of all melanoma patients, tumor growth is driven by gain-of-function mutations of BRAF (v-rat fibrosarcoma (Raf) murine sarcoma viral oncogene homolog B), which results in constitutive ERK activation. Patients with a BRAF mutation are regularly treated with a combination of BRAF and MEK (MAPK/ERK kinase) inhibitors. Next to the antiproliferative effects of BRAF/MEKi, accumulating preclinical evidence suggests that BRAF/MEKi exert immunomodulatory functions such as paradoxical ERK activation as well as additional effects in non-tumor cells. In this review, we present the current knowledge on the immunomodulatory functions of BRAF/MEKi as well as the non-intended effects of ICI and discuss the potential synergistic effects of ICI and MAPK inhibitors in melanoma treatment.
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Lacouture ME, Wainberg ZA, Patel AB, Anadkat MJ, Stemmer SM, Shacham-Shmueli E, Medina E, Zelinger G, Shelach N, Ribas A. Reducing Skin Toxicities from EGFR Inhibitors with Topical BRAF Inhibitor Therapy. Cancer Discov 2021; 11:2158-2167. [PMID: 33910927 PMCID: PMC8418997 DOI: 10.1158/2159-8290.cd-20-1847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/14/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
Treatment of cancer with EGFR inhibitors is limited by on-target skin toxicities induced by inhibition of the MAPK pathway. BRAF inhibitors are known to paradoxically activate the MAPK downstream of EGFR, which we confirmed using human skin keratinocytes. We then conducted a phase I clinical trial testing the hypothesis that topical therapy with the BRAF inhibitor LUT014 could improve skin toxicities induced by EGFR inhibitors. Ten patients with metastatic colorectal cancer who had developed acneiform rash while being treated with cetuximab or panitumumab were enrolled in three cohorts. LUT014 was well tolerated, and there were no dose-limiting toxicities. The acneiform rash improved in the 6 patients who started with grade 2 rash in the low and intermediate cohorts. We conclude that topical LUT014 is safe and efficacious in improving rash from EGFR inhibitors, consistent with the mechanism of action inducting paradoxical MAPK activation. SIGNIFICANCE: BRAF inhibitor topical therapy could avoid dose reductions of EGFR inhibitors, locally treating the main dose-limiting skin toxicity of this class of agents.This article is highlighted in the In This Issue feature, p. 2113.
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Affiliation(s)
| | - Zev A Wainberg
- University of California, Los Angeles (UCLA) and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Anisha B Patel
- The University of Texas MD Anderson Cancer Center (MDACC), Houston, Texas
| | - Milan J Anadkat
- Washington University School of Medicine, St. Louis, Missouri
| | - Salomon M Stemmer
- Davidoff Center, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Egmidio Medina
- University of California, Los Angeles (UCLA) and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | | | | | - Antoni Ribas
- University of California, Los Angeles (UCLA) and Jonsson Comprehensive Cancer Center, Los Angeles, California.
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29
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Valvo V, Iesato A, Kavanagh TR, Priolo C, Zsengeller Z, Pontecorvi A, Stillman IE, Burke SD, Liu X, Nucera C. Fine-Tuning Lipid Metabolism by Targeting Mitochondria-Associated Acetyl-CoA-Carboxylase 2 in BRAFV600E Papillary Thyroid Carcinoma. Thyroid 2021; 31:1335-1358. [PMID: 33107403 PMCID: PMC8558082 DOI: 10.1089/thy.2020.0311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: BRAFV600E acts as an ATP-dependent cytosolic kinase. BRAFV600E inhibitors are widely available, but resistance to them is widely reported in the clinic. Lipid metabolism (fatty acids) is fundamental for energy and to control cell stress. Whether and how BRAFV600E impacts lipid metabolism regulation in papillary thyroid carcinoma (PTC) is still unknown. Acetyl-CoA carboxylase (ACC) is a rate-limiting enzyme for de novo lipid synthesis and inhibition of fatty acid oxidation (FAO). ACC1 and ACC2 genes encode distinct isoforms of ACC. The aim of our study was to determine the relationship between BRAFV600E and ACC in PTC. Methods: We performed RNA-seq and DNA copy number analyses in PTC and normal thyroid (NT) in The Cancer Genome Atlas samples. Validations were performed by using assays on PTC-derived cell lines of differing BRAF status and a xenograft mouse model derived from a heterozygous BRAFWT/V600E PTC-derived cell line with knockdown (sh) of ACC1 or ACC2. Results:ACC2 mRNA expression was significantly downregulated in BRAFV600E-PTC vs. BRAFWT-PTC or NT clinical samples. ACC2 protein levels were downregulated in BRAFV600E-PTC cell lines vs. the BRAFWT/WT PTC cell line. Vemurafenib increased ACC2 (and to a lesser extent ACC1) mRNA levels in PTC-derived cell lines in a BRAFV600E allelic dose-dependent manner. BRAFV600E inhibition increased de novo lipid synthesis rates, and decreased FAO due to oxygen consumption rate (OCR), and extracellular acidification rate (ECAR), after addition of palmitate. Only shACC2 significantly increased OCR rates due to FAO, while it decreased ECAR in BRAFV600E PTC-derived cells vs. controls. BRAFV600E inhibition synergized with shACC2 to increase intracellular reactive oxygen species production, leading to increased cell proliferation and, ultimately, vemurafenib resistance. Mice implanted with a BRAFWT/V600E PTC-derived cell line with shACC2 showed significantly increased tumor growth after vemurafenib treatment, while vehicle-treated controls, or shGFP control cells treated with vemurafenib showed stable tumor growth. Conclusions: These findings suggest a potential link between BRAFV600E and lipid metabolism regulation in PTC. BRAFV600E downregulates ACC2 levels, which deregulates de novo lipid synthesis, FAO due to OCR, and ECAR rates. ShACC2 may contribute to vemurafenib resistance and increased tumor growth. ACC2 rescue may represent a novel molecular strategy for overcoming resistance to BRAFV600E inhibitors in refractory PTC.
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Affiliation(s)
- Veronica Valvo
- Laboratory of Human Thyroid Cancers Preclinical and Translational Research, Division of Experimental Pathology, Department of Pathology, Cancer Research Institute (CRI), Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Asumi Iesato
- Laboratory of Human Thyroid Cancers Preclinical and Translational Research, Division of Experimental Pathology, Department of Pathology, Cancer Research Institute (CRI), Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Taylor R. Kavanagh
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carmen Priolo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alfredo Pontecorvi
- Department of Medicine, Agostino Gemelli Medical School, UCSC, Rome, Italy
| | - Isaac E. Stillman
- Department of Pathology; Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne D. Burke
- Department of Medicine; Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaowen Liu
- Department of Emergency Medicine; Harvard Medical School, Boston, Massachusetts, USA
| | - Carmelo Nucera
- Laboratory of Human Thyroid Cancers Preclinical and Translational Research, Division of Experimental Pathology, Department of Pathology, Cancer Research Institute (CRI), Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Center for Vascular Biology Research (CVBR); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Address correspondence to: Carmelo Nucera, MD, PhD, Laboratory of Human Thyroid Cancers Preclinical and Translational Research, Division of Experimental Pathology, Department of Pathology, Cancer Research Institute (CRI) Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Office: RN270K, 99 Brookline Avenue, Boston, MA 02215, USA.
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Marin-Bejar O, Rogiers A, Dewaele M, Femel J, Karras P, Pozniak J, Bervoets G, Van Raemdonck N, Pedri D, Swings T, Demeulemeester J, Borght SV, Lehnert S, Bosisio F, van den Oord JJ, Bempt IV, Lambrechts D, Voet T, Bechter O, Rizos H, Levesque MP, Leucci E, Lund AW, Rambow F, Marine JC. Evolutionary predictability of genetic versus nongenetic resistance to anticancer drugs in melanoma. Cancer Cell 2021; 39:1135-1149.e8. [PMID: 34143978 DOI: 10.1016/j.ccell.2021.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
Therapy resistance arises from heterogeneous drug-tolerant persister cells or minimal residual disease (MRD) through genetic and nongenetic mechanisms. A key question is whether specific molecular features of the MRD ecosystem determine which of these two distinct trajectories will eventually prevail. We show that, in melanoma exposed to mitogen-activated protein kinase therapeutics, emergence of a transient neural crest stem cell (NCSC) population in MRD concurs with the development of nongenetic resistance. This increase relies on a glial cell line-derived neurotrophic factor-dependent signaling cascade, which activates the AKT survival pathway in a focal adhesion kinase (FAK)-dependent manner. Ablation of the NCSC population through FAK inhibition delays relapse in patient-derived tumor xenografts. Strikingly, all tumors that ultimately escape this treatment exhibit resistance-conferring genetic alterations and increased sensitivity to extracellular signal-regulated kinase inhibition. These findings identify an approach that abrogates the nongenetic resistance trajectory in melanoma and demonstrate that the cellular composition of MRD deterministically imposes distinct drug resistance evolutionary paths.
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Affiliation(s)
- Oskar Marin-Bejar
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Aljosja Rogiers
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Michael Dewaele
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Julia Femel
- Ronald O. Perelman Department of Dermatology and Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Panagiotis Karras
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Joanna Pozniak
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Greet Bervoets
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Nina Van Raemdonck
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Dennis Pedri
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Toon Swings
- VIB Technology Watch, Technology Innovation Lab, VIB, Leuven, Belgium
| | - Jonas Demeulemeester
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven, Belgium; Cancer Genomic Laboratory, The Francis Crick Institute, London, UK
| | | | | | - Francesca Bosisio
- Laboratory of Translational Cell and Tissue Research, Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | - Joost J van den Oord
- Laboratory of Translational Cell and Tissue Research, Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | | | - Diether Lambrechts
- Laboratory of Translational Genetics, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory of Translational Genetics, Center for Human Genetics, KU Leuven, Belgium
| | - Thierry Voet
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven, Belgium; KU Leuven Institute for Single Cell Omics, LISCO, KU Leuven, Leuven, Belgium
| | - Oliver Bechter
- Department of General Medical Oncology UZ Leuven, Belgium
| | - Helen Rizos
- Macquarie University, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia
| | - Mitchell P Levesque
- Department of Dermatology, University of Zürich Hospital, University of Zürich, Zürich, Switzerland
| | - Eleonora Leucci
- Laboratory for RNA Cancer Biology, Department of Oncology, LKI, KU Leuven, Leuven, Belgium; Trace PDX Platform, Department of Oncology, LKI, KU Leuven, Leuven, Belgium
| | - Amanda W Lund
- Ronald O. Perelman Department of Dermatology and Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Florian Rambow
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Jean-Christophe Marine
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium.
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Batko S. Current perspectives on the treatment of BRAF mutated colorectal carcinoma. Klin Onkol 2021; 33:328-338. [PMID: 33108877 DOI: 10.14735/amko2020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Worldwide metastatic colorectal cancer is the second most common cause of death attributable to cancer. Advances in molecular dia-gnostics led to recognition of several molecular subtypes of this disease. BRAF mutated colorectal cancer define specific challenging subgroup associated with dismal prognosis, lower rate of response rate, shorter progression free survival and overall survival. Current treatment choices are associated with poor outcomes. For the first line treatment doublet or triplet chemotherapy plus antiangiogenic antibody is used. To date, there were no reasonable treatment options in the second line settings. Recently published BEACON trial sets new standard of treatment with combination of encorafenib plus cetuximab, which led to significantly longer overall survival and overall response compared to standard therapy. Furthermore, this combination has shown well-tolerated safety profile with manageable toxicities. PURPOSE The aim of this article is a review of current treatment options for BRAF mutated colorectal cancer.
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Babačić H, Eriksson H, Pernemalm M. Plasma proteome alterations by MAPK inhibitors in BRAF V600-mutated metastatic cutaneous melanoma. Neoplasia 2021; 23:783-791. [PMID: 34246984 PMCID: PMC8274243 DOI: 10.1016/j.neo.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
Approximately half of metastatic cutaneous melanomas (CM) harbor a mutation in the BRAF protooncogene, upregulating the mitogen-activated protein kinase (MAPK)-pathway. The development of inhibitors targeting the MAPK pathway (MAPKi), i.e., BRAF- and MEK-inhibitors (BRAFi and MEKi), have substantially improved the survival in BRAFV600E/K-mutated stage IV metastatic CM. However, most patients develop resistance to treatment and no predictive biomarkers exist in practice. This study aimed at discovering plasma proteome changes during treatment MAPKi in patients with metastatic (stage IV) CM. Matched plasma samples before (pre) and during treatment (trm) from 23 patients with stage IV CM, treated with BRAF-inhibitors (BRAFi) alone or BRAF- and MEK- inhibitors combined (BRAFi and MEKi), were collected and analyzed with targeted proteomics by proximity extension assays. Additionally, plasma from 9 patients treated with BRAFi and MEKi was analyzed with in-depth high-resolution isoelectric focusing liquid-chromatography mass-spectrometry proteomics. Alterations of plasma proteins involved in granzyme and interferon gamma pathways were detected in patients treated with BRAFi, and cell adhesion-, neutrophil degranulation-, and proteolysis pathways in patients treated with BRAFi and MEKi. Several proteins were associated with progression-free survival after MAPKi treatment. We show that the majority of the altered plasma proteins were traceable to BRAFV600E-mutant metastatic CM tissue at mRNA level in 154 patients from the TCGA, further strengthening their involvement in tumoral response to treatment. This wide screen of plasma proteins unravels proteins that may serve as predictive and/or prognostic biomarkers of MAPKi treatment, opening a window of opportunity for plasma biomarker discovery in MAPKi-treatment of BRAFV600-mutant metastatic CM.
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Affiliation(s)
- Haris Babačić
- Department of Oncology-Pathology, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
| | - Hanna Eriksson
- Theme Cancer / Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
| | - Maria Pernemalm
- Department of Oncology-Pathology, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
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Adamopoulos C, Ahmed TA, Tucker MR, Ung PMU, Xiao M, Karoulia Z, Amabile A, Wu X, Aaronson SA, Ang C, Rebecca VW, Brown BD, Schlessinger A, Herlyn M, Wang Q, Shaw DE, Poulikakos PI. Exploiting Allosteric Properties of RAF and MEK Inhibitors to Target Therapy-Resistant Tumors Driven by Oncogenic BRAF Signaling. Cancer Discov 2021; 11:1716-1735. [PMID: 33568355 PMCID: PMC8295204 DOI: 10.1158/2159-8290.cd-20-1351] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 12/19/2022]
Abstract
Current clinical RAF inhibitors (RAFi) inhibit monomeric BRAF (mBRAF) but are less potent against dimeric BRAF (dBRAF). RAFi equipotent for mBRAF and dBRAF have been developed but are predicted to have lower therapeutic index. Here we identify a third class of RAFi that selectively inhibits dBRAF over mBRAF. Molecular dynamic simulations reveal restriction of the movement of the BRAF αC-helix as the basis of inhibitor selectivity. Combination of inhibitors based on their conformation selectivity (mBRAF- plus dBRAF-selective plus the most potent BRAF-MEK disruptor MEK inhibitor) promoted suppression of tumor growth in BRAFV600E therapy-resistant models. Strikingly, the triple combination showed no toxicities, whereas dBRAF-selective plus MEK inhibitor treatment caused weight loss in mice. Finally, the triple combination achieved durable response and improved clinical well-being in a patient with stage IV colorectal cancer. Thus, exploiting allosteric properties of RAF and MEK inhibitors enables the design of effective and well-tolerated therapies for BRAFV600E tumors. SIGNIFICANCE: This work identifies a new class of RAFi that are selective for dBRAF over mBRAF and determines the basis of their selectivity. A rationally designed combination of RAF and MEK inhibitors based on their conformation selectivity achieved increased efficacy and a high therapeutic index when used to target BRAFV600E tumors.See related commentary by Zhang and Bollag, p. 1620.This article is highlighted in the In This Issue feature, p. 1601.
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Affiliation(s)
- Christos Adamopoulos
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tamer A Ahmed
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Peter M U Ung
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Min Xiao
- The Wistar Institute, Philadelphia, Pennsylvania
| | - Zoi Karoulia
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angelo Amabile
- Department of Genetics and Genomics Sciences, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xuewei Wu
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart A Aaronson
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Celina Ang
- Department of Medicine, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Brian D Brown
- Department of Genetics and Genomics Sciences, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Avner Schlessinger
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Qi Wang
- D. E. Shaw Research, New York, New York
| | - David E Shaw
- D. E. Shaw Research, New York, New York.
- Department of Biochemistry and Molecular Biophysics, Columbia University, New York, New York
| | - Poulikos I Poulikakos
- Department of Oncological Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Abstract
Melanoma accounts for approximately 1% of all skin cancers but contributes to almost all skin cancer deaths. The developing picture suggests that melanoma phenotypes are driven by epigenetic mechanisms that reflect a complex interplay between genotype and environment. Furthermore, the growing consensus is that current classification standards, notwithstanding pertinent clinical history and appropriate biopsy, fall short of capturing the vast complexity of the disease. This article summarizes the current understanding of the clinical picture of melanoma, with a focus on the tremendous breakthroughs in molecular classification and therapeutics.
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Affiliation(s)
- Sarem Rashid
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02466, USA; Boston University School of Medicine, Boston, MA, USA
| | - Hensin Tsao
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02466, USA.
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Escuin-Ordinas H, Liu Y, Sun L, Hugo W, Dimatteo R, Huang RR, Krystofinski P, Azhdam A, Lee J, Comin-Anduix B, Cochran AJ, Lo RS, Segura T, Scumpia PO, Ribas A. Wound healing with topical BRAF inhibitor therapy in a diabetic model suggests tissue regenerative effects. PLoS One 2021; 16:e0252597. [PMID: 34161353 PMCID: PMC8221471 DOI: 10.1371/journal.pone.0252597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/21/2021] [Indexed: 12/13/2022] Open
Abstract
Wound healing is a multi-step process to rapidly restore the barrier function. This process is often impaired in diabetic patients resulting in chronic wounds and amputation. We previously found that paradoxical activation of the mitogen-activated protein kinase (MAPK) pathway via topical administration of the BRAF inhibitor vemurafenib accelerates wound healing by activating keratinocyte proliferation and reepithelialization pathways in healthy mice. Herein, we investigated whether this wound healing acceleration also occurs in impaired diabetic wounds and found that topical vemurafenib not only improves wound healing in a murine diabetic wound model but unexpectedly promotes hair follicle regeneration. Hair follicles expressing Sox-9 and K15 surrounded by CD34+ stroma were found in wounds of diabetic and non-diabetic mice, and their formation can be prevented by blocking downstream MEK signaling. Thus, topically applied BRAF inhibitors may accelerate wound healing, and promote the restoration of improved skin architecture in both normal and impaired wounds.
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Affiliation(s)
- Helena Escuin-Ordinas
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
- * E-mail: (AR); (HEO)
| | - Yining Liu
- Department of Chemical and Biomolecular Engineering, UCLA, Los Angeles, California, United States of America
| | - Lu Sun
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, California, United States of America
| | - Willy Hugo
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, California, United States of America
| | - Robert Dimatteo
- Department of Chemical and Biomolecular Engineering, UCLA, Los Angeles, California, United States of America
| | - Rong Rong Huang
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California, United States of America
| | - Paige Krystofinski
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Ariel Azhdam
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Jordan Lee
- Department of Dermatology, VA Greater Los Angeles Healthcare System-West Los Angeles, Los Angeles, California, United States of America
| | - Begoña Comin-Anduix
- Division of Surgical Oncology, Department of Surgery, UCLA, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, United States of America
| | - Alistair J. Cochran
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California, United States of America
| | - Roger S. Lo
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, United States of America
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, United States of America
| | - Tatiana Segura
- Department of Chemical and Biomolecular Engineering, UCLA, Los Angeles, California, United States of America
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Philip O. Scumpia
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, California, United States of America
- Department of Dermatology, VA Greater Los Angeles Healthcare System-West Los Angeles, Los Angeles, California, United States of America
| | - Antoni Ribas
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
- Division of Surgical Oncology, Department of Surgery, UCLA, Los Angeles, California, United States of America
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, United States of America
- Department of Biological Chemistry, UCLA, Los Angeles, California, United States of America
- * E-mail: (AR); (HEO)
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Wang Y, Hu Z, Ma W, Niu Y, Su J, Zhang L, Zhao P. Signal transducer and activator of transcription 3 inhibition alleviates resistance to BRAF inhibition in anaplastic thyroid cancer. Invest New Drugs 2021; 39:764-774. [PMID: 33245464 DOI: 10.1007/s10637-020-01024-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022]
Abstract
Anaplastic thyroid cancer (ATC) is a rare type of thyroid cancer (TC) with no effective therapeutic strategy. Although surgery, chemotherapy and radiation are all available for ATC treatment, the median survival for ATC patients is less than 6 months. In this study, we aimed to study on resistant mechanisms to B-Raf proto-oncogene serine/threonine kinase (BRAF) inhibitor and identify effective combinational therapy for ATC patients. TC cells were treated with Vemurafenib and cell apoptosis and viability were analyzed by flow cytometry and MTT assay. Monolayer and sphere cells were isolated from ATC cells to detect the mRNA level of stem cell markers and differentiation markers by RT-PCR. Phosphor-STAT3 level in sphere and monolayer cells was tested by Western blotting. The xenotransplantation animal model has established to analyze the anti-tumor effect of Vemurafenib and Stattic combinational therapy. Undifferentiated TC cells were resistant to Vemurafenib treatment. Sphere cells isolated from ATC showed no significant change in cell viability and apoptosis upon Vemurafenib treatment, and expressed a high level of stem cell marker and phosphor-STAT3. STAT3 inhibition enhanced the tumorigenic capacity and increased Vemurafenib sensitivity in ATC cell lines. Stattic significantly enhanced anti-tumor effect of Vemurafenib in mouse model. Our findings demonstrate that the combinational therapy of Vemurafenib and Stattic is an effective therapeutic treatment for ATC patients.
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Affiliation(s)
- Ying Wang
- The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Zhigang Hu
- The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Weiyuan Ma
- The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, 050000, Hebei, China
| | - Yong Niu
- Quyang People's Hospital, Taihang Road, Quyang County, Baoding, 071000, Hebei, China
| | - Jingwei Su
- Quyang People's Hospital, Taihang Road, Quyang County, Baoding, 071000, Hebei, China
| | - Lingxiang Zhang
- Xingtai Ninth Hospital, No.163 Jiankang East Road, Julu County, Xingtai, 054000, Hebei, China
| | - Pengxin Zhao
- The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, 050000, Hebei, China.
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37
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Guha A, Jain P, Fradley MG, Lenihan D, Gutierrez JM, Jain C, de Lima M, Barnholtz‐Sloan JS, Oliveira GH, Dowlati A, Al‐Kindi S. Cardiovascular adverse events associated with BRAF versus BRAF/MEK inhibitor: Cross-sectional and longitudinal analysis using two large national registries. Cancer Med 2021; 10:3862-3872. [PMID: 33982883 PMCID: PMC8209554 DOI: 10.1002/cam4.3938] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cardiovascular adverse events (CVAEs) associated with BRAF inhibitors alone versus combination BRAF/MEK inhibitors are not fully understood. METHODS This study included all adult patients who received BRAF inhibitors (vemurafenib, dabrafenib, encorafenib) or combinations BRAF/MEK inhibitors (vemurafenib/cobimetinib; dabrafenib/trametinib; encorafenib/binimetinib). We utilized the cross-sectional FDA's Adverse Events Reporting System (FAERS) and longitudinal Truven Health Analytics/IBM MarketScan database from 2011 to 2018. Various CVAEs, including arterial hypertension, heart failure (HF), and venous thromboembolism (VTE), were studied using adjusted regression techniques. RESULTS In FAERS, 7752 AEs were reported (40% BRAF and 60% BRAF/MEK). Median age was 60 (IQR 49-69) years with 45% females and 97% with melanoma. Among these, 567 (7.4%) were cardiovascular adverse events (mortality rate 19%). Compared with monotherapy, combination therapy was associated with increased risk for HF (reporting odds ratio [ROR] = 1.62 (CI = 1.14-2.30); p = 0.007), arterial hypertension (ROR = 1.75 (CI = 1.12-2.89); p = 0.02) and VTE (ROR = 1.80 (CI = 1.12-2.89); p = 0.02). Marketscan had 657 patients with median age of 53 years (IQR 46-60), 39.3% female, and 88.7% with melanoma. There were 26.2% CVAEs (CI: 14.8%-36%) within 6 months of medication start in those receiving combination therapy versus 16.7% CVAEs (CI: 13.1%-20.2%) among those receiving monotherapy. Combination therapy was associated with CVAEs compared to monotherapy (adjusted HR: 1.56 (CI: 1.01-2.42); p = 0.045). CONCLUSIONS AND RELEVANCE In two independent real-world cohorts, combination BRAF/MEK inhibitors were associated with increased CVAEs compared to monotherapy, especially HF, and hypertension.
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Affiliation(s)
- Avirup Guha
- Harrington Heart and Vascular InstituteUniversity HospitalsCase Western Reserve UniversityClevelandOHUSA
| | - Prantesh Jain
- Division of Hematology and Medical OncologyUniversity Hospitals Cleveland Medical CenterSeidman Cancer Center at Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOHUSA
| | - Michael G. Fradley
- Cardio‐Oncology ProgramDivision of CardiologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Daniel Lenihan
- Cardio‐Oncology Center of ExcellenceDivision of CardiologyWashington University in St LouisSt. LouisMOUSA
| | | | - Chhavi Jain
- Lerner Research InstituteCleveland ClinicCase Comprehensive Cancer CenterClevelandOHUSA
| | - Marcos de Lima
- Division of Hematology and Medical OncologyUniversity Hospitals Cleveland Medical CenterSeidman Cancer Center at Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOHUSA
| | - Jill S. Barnholtz‐Sloan
- Department of Population and Quantitative Health SciencesCase Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - Guilherme H. Oliveira
- Division of Cardiovascular SciencesCardio‐Oncology ProgramUniversity of South FloridaTampa General Hospital and Moffitt Cancer CenterTampaFLUSA
| | - Afshin Dowlati
- Division of Hematology and Medical OncologyUniversity Hospitals Cleveland Medical CenterSeidman Cancer Center at Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOHUSA
| | - Sadeer Al‐Kindi
- Harrington Heart and Vascular InstituteUniversity HospitalsCase Western Reserve UniversityClevelandOHUSA
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38
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Mian P, Meussen E, Piersma D, Lankheet NAG. Relatively mild symptoms after chronic overdose with a double-dose encorafenib: a case report. Anticancer Drugs 2021; 32:589-591. [PMID: 33587356 DOI: 10.1097/cad.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Encorafenib (Braftovi) is indicated for the treatment of adult patients with unresectable or metastatic melanoma with a BRAF V600 mutation, in combination with binimetinib (Mektovi). According to the product label of encorafenib, there are no specific treatment recommendations in case of an overdose. We report on a 63-year-old man who ingested a double dose (900 mg) of encorafenib for 16 days. He developed overall minor chronic overdose symptoms such as nausea and vomiting grade 1 and muscle pain. Based on the most occurring adverse events of encorafenib, liver values, kidney function parameters and QTc interval were measured. Kidney function parameters were normal, whereas liver values were slightly increased (grade 1) and QTc slightly prolonged. The plasma concentration 3 h after the last dose was 2110 ng/mL. We describe the course of a case with a chronic overdose during 16 days of the double dose of encorafenib as well as the followed approach, which could be taken into account when observing an encorafenib overdose. Providing information in times of Covid-19 is challenging, but remains necessary for good clinical care.
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Affiliation(s)
| | - Elvera Meussen
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
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39
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Sanchez JN, Subramanian C, Chanda M, Gary S, Zhang N, Wang T, Timmermann BN, Blagg BS, Cohen MS. A novel C-terminal Hsp90 inhibitor KU758 synergizes efficacy in combination with BRAF or MEK inhibitors and targets drug-resistant pathways in BRAF-mutant melanomas. Melanoma Res 2021; 31:197-207. [PMID: 33904516 PMCID: PMC10565508 DOI: 10.1097/cmr.0000000000000734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Melanoma remains the most aggressive and fatal form of skin cancer, despite several FDA-approved targeted chemotherapies and immunotherapies for use in advanced disease. Of the 100 350 new patients diagnosed with melanoma in 2020 in the US, more than half will develop metastatic disease leading to a 5-year survival rate <30%, with a majority of these developing drug-resistance within the first year of treatment. These statistics underscore the critical need in the field to develop more durable therapeutics as well as those that can overcome chemotherapy-induced drug resistance from currently approved agents. Fortunately, several of the drug-resistance pathways in melanoma, including the proteins in those pathways, rely in part on Hsp90 chaperone function. This presents a unique and novel opportunity to simultaneously target multiple proteins and drug-resistant pathways in this disease via molecular chaperone inhibition. Taken together, we hypothesize that our novel C-terminal Hsp90 inhibitor, KU758, in combination with the current standard of care targeted therapies (e.g. vemurafenib and cobimetinib) can both synergize melanoma treatment efficacy in BRAF-mutant tumors, as well as target and overcome several major resistance pathways in this disease. Using in vitro proliferation and protein-based Western Blot analyses, our novel inhibitor, KU758, potently inhibited melanoma cell proliferation (without induction of the heat shock response) in vitro and synergized with both BRAF and MEK inhibitors in inhibition of cell migration and protein expression from resistance pathways. Overall, our work provides early support for further translation of C-terminal Hsp90 inhibitor and mitogen-activated protein kinase pathway inhibitor combinations as a novel therapeutic strategy for BRAF-mutant melanomas.
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Affiliation(s)
- Jackee N. Sanchez
- Department of Pharmacology, University of Michigan, Ann Arbor, Michigan
| | | | - Monica Chanda
- Department of Pharmacology, University of Michigan, Ann Arbor, Michigan
| | - Shanguan Gary
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nina Zhang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ton Wang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Brian S.J. Blagg
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
| | - Mark S. Cohen
- Department of Pharmacology, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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40
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Abstract
Non-small cell lung cancer (NSCLC) is one of the most frequent causes of mortality in the western world. v-raf murine sarcoma viral oncogene homolog B (BRAF) is a member of the Raf kinase family and plays a critical role in cellular growth, proliferation, and differentiation through the mitogen-activated protein kinase pathway. The incidence of BRAF mutations in NSCLC is low, accounting for 0-3% of all cases of lung cancer. Given the results obtained in metastatic melanoma, several studies have reported the efficacy of anti-BRAF therapies in NSCLC treatment. In this review, we describe changes in the landscape of BRAF-mutated lung cancer treatment and analyze insights from major clinical trials in the context of future therapeutic prospects.
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Affiliation(s)
- Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, viale Pieraccini, 6, 50139, Florence, Italy.
| | - Alberto D'Angelo
- Department of Biology & Biochemistry, University of Bath, Bath, BA2-7AX, UK
| | - Marianna Sirico
- Multidisciplinary Operative Unit of Mammary Pathology and Translational Research, ASST of Cremona, 26100, Cremona, Italy
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matteo Pittacolo
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Felipe Umpierre Conter
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Navid Sobhani
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
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41
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Ziogas DC, Konstantinou F, Bouros S, Theochari M, Gogas H. Combining BRAF/MEK Inhibitors with Immunotherapy in the Treatment of Metastatic Melanoma. Am J Clin Dermatol 2021; 22:301-314. [PMID: 33765322 DOI: 10.1007/s40257-021-00593-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Abstract
The management and prognosis of BRAF-mutant metastatic melanoma have changed drastically following the introduction of immune checkpoint inhibitors and molecularly targeted agents. These treatment options present different mechanisms of action and toxicities but also totally distinct kinetics of their response, including a "relatively" short-lasting benefit in subsets of patients treated with BRAF/MEK inhibitors and a lower response rate in patients treated with immune checkpoint inhibitors. BRAF/MEK inhibitors, when administered prior to or concurrently with immune checkpoint inhibitors, at least transiently alter some immunosuppressive parameters of the tumor microenvironment and theoretically improve sensitivity to immunotherapy. Preclinical data from mouse models with oncogene-addicted melanoma confirmed this beneficial immune/targeted synergy and supported the clinical testing of combinations of BRAF/MEK inhibitors and immune checkpoint inhibitors to improve the activity of upfront anti-melanoma therapies. The first positive phase III results were published in 2020, and triggered the discussion about the benefits, the limitations, as well as the possible implications of combining or sequencing targeted therapies with immune checkpoint inhibitors in everyday practice. Beginning from the interplay of immune/targeted agents within the melanoma microenvironment, this review outlines available information from the retrospective experience up to the late-stage randomized evidence on combinatorial treatments. Many clinical trials are currently underway exploring open questions about optimal timing, new immune biomarkers, and eligible patient subsets for these immune/targeted regimens. Awaiting these results, decision making in the first-line setting for BRAF-mutant melanoma is still guided by the patients' characteristics and the biological aspects of melanoma.
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Affiliation(s)
- Dimitrios C Ziogas
- School of Medicine, First Department of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 75, Mikras Asias str., Goudi, 11527, Athens, Greece
| | - Frosso Konstantinou
- School of Medicine, First Department of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 75, Mikras Asias str., Goudi, 11527, Athens, Greece
| | - Spyros Bouros
- School of Medicine, First Department of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 75, Mikras Asias str., Goudi, 11527, Athens, Greece
| | - Maria Theochari
- School of Medicine, First Department of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 75, Mikras Asias str., Goudi, 11527, Athens, Greece
| | - Helen Gogas
- School of Medicine, First Department of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 75, Mikras Asias str., Goudi, 11527, Athens, Greece.
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42
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Abstract
Encorafenib (Braftovi®) is an oral small molecule BRAF inhibitor used in combination with cetuximab for the treatment of adult patients with metastatic colorectal cancer (mCRC) with a BRAF V600E mutation, who have received prior systemic therapy. In a clinical trial in adults with BRAF V600E-mutated mCRC who had disease progression after one or two previous regimens (BEACON CRC), encorafenib plus cetuximab was associated with a significantly longer median overall survival (OS), a higher objective response rate (ORR) and longer median progression-free survival (PFS), compared with standard therapy. Encorafenib plus cetuximab had a manageable tolerability profile in BEACON CRC. Current evidence suggests that encorafenib plus cetuximab combination therapy is an important targeted regimen for patients with mCRC and a BRAF V600E mutation who have received prior therapy.
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Affiliation(s)
- Zaina T Al-Salama
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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43
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Shami Shah A, Cao X, White AC, Baskin JM. PLEKHA4 Promotes Wnt/β-Catenin Signaling-Mediated G 1-S Transition and Proliferation in Melanoma. Cancer Res 2021; 81:2029-2043. [PMID: 33574086 PMCID: PMC8137570 DOI: 10.1158/0008-5472.can-20-2584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/29/2020] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
Despite recent promising advances in targeted therapies and immunotherapies, patients with melanoma incur substantial mortality. In particular, inhibitors targeting BRAF-mutant melanoma can lead to resistance, and no targeted therapies exist for NRAS-mutant melanoma, motivating the search for additional therapeutic targets and vulnerable pathways. Here we identify a regulator of Wnt/β-catenin signaling, PLEKHA4, as a factor required for melanoma proliferation and survival. PLEKHA4 knockdown in vitro decreased Dishevelled levels, attenuated Wnt/β-catenin signaling, and blocked progression through the G1-S cell-cycle transition. In mouse xenograft and allograft models, inducible PLEKHA4 knockdown attenuated tumor growth in BRAF- and NRAS-mutant melanomas and exhibited an additive effect with the clinically used inhibitor encorafenib in a BRAF-mutant model. As an E3 ubiquitin ligase regulator with both lipid- and protein-binding partners, PLEKHA4 presents several opportunities for targeting with small molecules. Our work identifies PLEKHA4 as a promising drug target for melanoma and clarifies a controversial role for Wnt/β-catenin signaling in the control of melanoma proliferation. SIGNIFICANCE: This study establishes that melanoma cell proliferation requires the protein PLEKHA4 to promote pathologic Wnt signaling for proliferation, highlighting PLEKHA4 inhibition as a new avenue for the development of targeted therapies.
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Affiliation(s)
- Adnan Shami Shah
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York
- Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, New York
| | - Xiaofu Cao
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York
- Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, New York
| | - Andrew C White
- Department of Biomedical Sciences, Cornell University, Ithaca, New York
| | - Jeremy M Baskin
- Department of Chemistry and Chemical Biology, Cornell University, Ithaca, New York.
- Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, New York
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44
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Zewdu R, Mehrabad EM, Ingram K, Fang P, Gillis KL, Camolotto SA, Orstad G, Jones A, Mendoza MC, Spike BT, Snyder EL. An NKX2-1/ERK/WNT feedback loop modulates gastric identity and response to targeted therapy in lung adenocarcinoma. eLife 2021; 10:e66788. [PMID: 33821796 PMCID: PMC8102067 DOI: 10.7554/elife.66788] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer cells undergo lineage switching during natural progression and in response to therapy. NKX2-1 loss in human and murine lung adenocarcinoma leads to invasive mucinous adenocarcinoma (IMA), a lung cancer subtype that exhibits gastric differentiation and harbors a distinct spectrum of driver oncogenes. In murine BRAFV600E-driven lung adenocarcinoma, NKX2-1 is required for early tumorigenesis, but dispensable for established tumor growth. NKX2-1-deficient, BRAFV600E-driven tumors resemble human IMA and exhibit a distinct response to BRAF/MEK inhibitors. Whereas BRAF/MEK inhibitors drive NKX2-1-positive tumor cells into quiescence, NKX2-1-negative cells fail to exit the cell cycle after the same therapy. BRAF/MEK inhibitors induce cell identity switching in NKX2-1-negative lung tumors within the gastric lineage, which is driven in part by WNT signaling and FoxA1/2. These data elucidate a complex, reciprocal relationship between lineage specifiers and oncogenic signaling pathways in the regulation of lung adenocarcinoma identity that is likely to impact lineage-specific therapeutic strategies.
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Affiliation(s)
- Rediet Zewdu
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Pathology, University of UtahSalt Lake CityUnited States
| | - Elnaz Mirzaei Mehrabad
- Huntsman Cancer InstituteSalt Lake CityUnited States
- School of Computing, University of UtahSalt Lake CityUnited States
| | - Kelley Ingram
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Pengshu Fang
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Katherine L Gillis
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Soledad A Camolotto
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Pathology, University of UtahSalt Lake CityUnited States
| | - Grace Orstad
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Alex Jones
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Pathology, University of UtahSalt Lake CityUnited States
| | - Michelle C Mendoza
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Benjamin T Spike
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
| | - Eric L Snyder
- Huntsman Cancer InstituteSalt Lake CityUnited States
- Department of Pathology, University of UtahSalt Lake CityUnited States
- Department of Oncological Sciences, University of UtahSalt Lake CityUnited States
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45
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Ito RE, Oneyama C, Aoki K. Oncogenic mutation or overexpression of oncogenic KRAS or BRAF is not sufficient to confer oncogene addiction. PLoS One 2021; 16:e0249388. [PMID: 33793658 PMCID: PMC8016361 DOI: 10.1371/journal.pone.0249388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
Oncogene addiction is a cellular property by which cancer cells become highly dependent on the expression of oncogenes for their survival. Oncogene addiction can be exploited to design molecularly targeted drugs that kill only cancer cells by inhibiting the specific oncogenes. Genes and cell lines exhibiting oncogene addiction, as well as the mechanisms by which cell death is induced when addicted oncogenes are suppressed, have been extensively studied. However, it is still not fully understood how oncogene addiction is acquired in cancer cells. Here, we take a synthetic biology approach to investigate whether oncogenic mutation or oncogene expression suffices to confer the property of oncogene addiction to cancer cells. We employed human mammary epithelium-derived MCF-10A cells expressing the oncogenic KRAS or BRAF. MCF-10A cells harboring an oncogenic mutation in a single-allele of KRAS or BRAF showed weak transformation activity, but no characteristics of oncogene addiction. MCF-10A cells overexpressing oncogenic KRAS demonstrated the transformation activity, but MCF-10A cells overexpressing oncogenic BRAF did not. Neither cell line exhibited any oncogene addiction properties. These results indicate that the introduction of oncogenic mutation or the overexpression of oncogenes is not sufficient for cells to acquire oncogene addiction, and that oncogene addiction is not associated with transformation activity.
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Affiliation(s)
- Reina E. Ito
- Quantitative Biology Research Group, Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Okazaki, Aichi, Japan
- Division of Quantitative Biology, National Institute for Basic Biology, National Institutes of Natural Sciences, Okazaki, Aichi, Japan
| | - Chitose Oneyama
- Division of Cancer Cell Regulation, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Kazuhiro Aoki
- Quantitative Biology Research Group, Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Okazaki, Aichi, Japan
- Division of Quantitative Biology, National Institute for Basic Biology, National Institutes of Natural Sciences, Okazaki, Aichi, Japan
- Department of Basic Biology, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, Aichi, Japan
- * E-mail:
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46
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Harbers FN, Thier B, Stupia S, Zhu S, Schwamborn M, Peller V, Chauvistré H, Crivello P, Fleischhauer K, Roesch A, Sucker A, Schadendorf D, Chen Y, Paschen A, Zhao F. Melanoma Differentiation Trajectories Determine Sensitivity Toward Pre-Existing CD8 + Tumor-Infiltrating Lymphocytes. J Invest Dermatol 2021; 141:2480-2489. [PMID: 33798535 DOI: 10.1016/j.jid.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
The highly plastic nature of melanoma enables its transition among diverse cell states to survive hostile conditions. However, the interplay between specific tumor cell states and intratumoral T cells remains poorly defined. With MAPK inhibitor‒treated BRAFV600-mutant tumors as models, we linked human melanoma state transition to CD8+ T cell responses. Repeatedly, we observed that isogenic melanoma cells could evolve along distinct differentiation trajectories on single BRAF inhibitor (BRAFi) treatment or dual BRAFi/MEKi treatment, resulting in BRAFi‒induced hyperdifferentiated and BRAFi/MEKi‒induced dedifferentiated resistant subtypes. Taking advantage of patient-derived autologous CD8+ tumor-infiltrating lymphocytes (TILs), we demonstrate that progressive melanoma cell state transition profoundly affects TIL function. Tumor cells along the hyperdifferentiation trajectory continuously gained sensitivity toward tumor-reactive CD8+ TILs, whereas those in the dedifferentiation trajectory acquired T cell resistance in part owing to the loss of differentiation antigens. Overall, our data reveal the tight connection of MAPKi‒induced temporary (drug-tolerant transition state) and stable (resistant state) phenotype alterations with T cell function and further broaden the current knowledge on melanoma plasticity in terms of sculpting local antitumor immune responses, with implications for guiding the optimal combination of targeted therapy and immunotherapy.
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Affiliation(s)
- Franziska Noelle Harbers
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Beatrice Thier
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Simone Stupia
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Si Zhu
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Marion Schwamborn
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Vicky Peller
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Heike Chauvistré
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Pietro Crivello
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
| | | | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Yong Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Fang Zhao
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany.
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Abstract
The treatment landscape for patients with advanced melanoma has dramatically improved over the past decade, leading to unprecedented survival. Despite the robust activity of single-agent immune-checkpoint blockade with anti-CTLA-4 or anti-PD-1 agents, and the efficacy of targeted therapies capable of interrupting aberrant signaling resulting from BRAF mutations, the benefit from these therapies is not universal. Advanced understanding of immune and molecular processes underlying melanoma tumorigenesis has demonstrated the promise of combined, multidrug regimens. We discuss the currently available evidence that supports using combinatorial approaches in advanced melanoma treatment and provide insights into promising new combination strategies under investigation.
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Affiliation(s)
- Rodrigo Ramella Munhoz
- Oncology Center, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.
| | - Michael Andrew Postow
- Melanoma Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA
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48
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Phadke MS, Chen Z, Li J, Mohamed E, Davies MA, Smalley I, Duckett DR, Palve V, Czerniecki BJ, Forsyth PA, Noyes D, Adeegbe DO, Eroglu Z, Nguyen KT, Tsai KY, Rix U, Burd CE, Chen YA, Rodriguez PC, Smalley KSM. Targeted Therapy Given after Anti-PD-1 Leads to Prolonged Responses in Mouse Melanoma Models through Sustained Antitumor Immunity. Cancer Immunol Res 2021; 9:554-567. [PMID: 33653716 DOI: 10.1158/2326-6066.cir-20-0905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Immunotherapy (IT) and targeted therapy (TT) are both effective against melanoma, but their combination is frequently toxic. Here, we investigated whether the sequence of IT (anti-PD-1)→ TT (ceritinib-trametinib or dabrafenib-trametinib) was associated with improved antitumor responses in mouse models of BRAF- and NRAS-mutant melanoma. Mice with NRAS-mutant (SW1) or BRAF-mutant (SM1) mouse melanomas were treated with either IT, TT, or the sequence of IT→TT. Tumor volumes were measured, and samples from the NRAS-mutant melanomas were collected for immune-cell analysis, single-cell RNA sequencing (scRNA-seq), and reverse phase protein analysis (RPPA). scRNA-seq demonstrated that the IT→TT sequence modulated the immune environment, leading to increased infiltration of T cells, monocytes, dendritic cells and natural killer cells, and decreased numbers of tumor-associated macrophages, myeloid-derived suppressor cells, and regulatory T cells. Durable responses to the IT→TT sequence were dependent on T-cell activity, with depletion of CD8+, but not CD4+, T cells abrogating the therapeutic response. An analysis of transcriptional heterogeneity in the melanoma compartment showed the sequence of IT→TT enriched for a population of melanoma cells with increased expression of MHC class I and melanoma antigens. RPPA analysis demonstrated that the sustained immune response induced by IT→TT suppressed tumor-intrinsic signaling pathways required for therapeutic escape. These studies establish that upfront IT improves the responses to TT in BRAF- and NRAS-mutant melanoma models.
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Affiliation(s)
- Manali S Phadke
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zhihua Chen
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jiannong Li
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eslam Mohamed
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michael A Davies
- The Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Inna Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Derek R Duckett
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vinayak Palve
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brian J Czerniecki
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A Forsyth
- The Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - David Noyes
- The Department of Malignant Hematology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Dennis O Adeegbe
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zeynep Eroglu
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kimberly T Nguyen
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kenneth Y Tsai
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Uwe Rix
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christin E Burd
- Department of Cancer Biology and Genetics, Ohio State University, Columbus, Ohio
| | - Yian A Chen
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paulo C Rodriguez
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Keiran S M Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
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49
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Abstract
PURPOSE OF REVIEW Patients with advanced or metastatic v-raf murine sarcoma viral oncogene homolog B1 (BRAF)-mutated melanoma can be treated with a BRAF inhibitor in combination with a MAPK/ERK kinase (MEK) inhibitor, achieving high but short-lived response rates. Immune checkpoint inhibitors (ICIs), in contrast, give lower response rates but more durable responses. Preclinical and translational data indicate that combining BRAF and MEK inhibitors with ICI could exceed the limitations of each class and potentially lead to longer lasting responses. RECENT FINDINGS Vemurafenib, dabrafenib and encorafenib are designed to block mutated forms of BRAF, which cause abnormal signalling inside cancer cells leading to tumour growth. Trametinib, binimetinib and cobimetinib are designed to target and inhibit MEK1/2, proteins in a cell signalling pathway that help cell growth and survival. Pembrolizumab, nivolumab, durvalumab and atezolizumab are ICIs which can inhibit the pathway of programmed death-1/ programmed death-ligand-1 proteins, allowing tumours to avoid detection by the immune system. SUMMARY Treating patients with targeted therapy would allow the release of antigens from tumour cells, which could be more easily acknowledged by the immune system. Efficacy can also be increased by combining ICIs with the aim of maintaining a longer response. The possibility to administer three drugs in combination, would allow to induce tumour regression and produce an immune response with a synergistic effect.
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Affiliation(s)
- Claudia Trojaniello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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50
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Abstract
PURPOSE OF REVIEW BRAF/MEK inhibitor has changed the treatment landscape in patients with advanced and metastatic melanoma with prolonged overall survival and progression-free survival. Since three treatment combinations exist with similar efficacy therapy decisions are often made based on the side effect profile. Additionally, on-target side effects or class effects have to be properly managed to ensure treatment adherence. RECENT FINDINGS Sequential treatment with BRAF/MEK inhibition and immunotherapy might increase toxicity with a sepsis-like syndrome and triple therapy with concomitant BRAF/MEK inhibition and anti-PD1/PD-L1 antibody therapy induces severe side effects in the vast majority of patients. SUMMARY Toxicity of combination therapy with BRAF/MEK inhibitors is generally manageable, reversible and infrequently associated with treatment discontinuation. In case of persisting off-target effects the change to another combination therapy can resolve side effects.
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Affiliation(s)
- Alvaro Moreira
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
- The Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, New York, NY, USA
| | - Céleste Lebbé
- Université de Paris, AP-HP Dermatology, INSERM U976, Saint Louis Hospital, Paris, France
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum München (LMU), Munich, Germany
- Department of Dermatology, Universitätsklinikum Erlangen, Germany and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
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