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Griffin M, Scotto D, Josephs DH, Mele S, Crescioli S, Bax HJ, Pellizzari G, Wynne MD, Nakamura M, Hoffmann RM, Ilieva KM, Cheung A, Spicer JF, Papa S, Lacy KE, Karagiannis SN. BRAF inhibitors: resistance and the promise of combination treatments for melanoma. Oncotarget 2017; 8:78174-78192. [PMID: 29100459 PMCID: PMC5652848 DOI: 10.18632/oncotarget.19836] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/25/2017] [Indexed: 12/31/2022] Open
Abstract
Identification of mutations in the gene encoding the serine/threonine-protein kinase, BRAF, and constitutive activation of the mitogen-activated protein kinase (MAPK) pathway in around 50% of malignant melanomas have led to the development and regulatory approval of targeted pathway inhibitor drugs. A proportion of patients are intrinsically resistant to BRAF inhibitors, and most patients who initially respond, acquire resistance within months. In this review, we discuss pathway inhibitors and their mechanisms of resistance, and we focus on numerous efforts to improve clinical benefits through combining agents with disparate modes of action, including combinations with checkpoint inhibitor antibodies. We discuss the merits of combination strategies based on enhancing immune responses or overcoming tumor-associated immune escape mechanisms. Emerging insights into mechanisms of action, resistance pathways and their impact on host-tumor relationships will inform the design of optimal combinations therapies to improve outcomes for patients who currently do not benefit from recent treatment breakthroughs.
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Affiliation(s)
- Merope Griffin
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Daniele Scotto
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Debra H Josephs
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Research Oncology, School of Cancer Sciences, King's College London, Guy's Hospital, Bermondsey Wing, London, UK
| | - Silvia Mele
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Silvia Crescioli
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Heather J Bax
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Research Oncology, School of Cancer Sciences, King's College London, Guy's Hospital, Bermondsey Wing, London, UK
| | - Giulia Pellizzari
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Research Oncology, School of Cancer Sciences, King's College London, Guy's Hospital, Bermondsey Wing, London, UK
| | - Matthew D Wynne
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Mano Nakamura
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Ricarda M Hoffmann
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Kristina M Ilieva
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Breast Cancer Now Unit, School of Cancer Sciences, King's College London, Guy's Cancer Centre, London, UK
| | - Anthony Cheung
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Breast Cancer Now Unit, School of Cancer Sciences, King's College London, Guy's Cancer Centre, London, UK
| | - James F Spicer
- Research Oncology, School of Cancer Sciences, King's College London, Guy's Hospital, Bermondsey Wing, London, UK
| | - Sophie Papa
- Research Oncology, School of Cancer Sciences, King's College London, Guy's Hospital, Bermondsey Wing, London, UK
| | - Katie E Lacy
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK
| | - Sophia N Karagiannis
- St John's Institute of Dermatology, Genetics and Molecular Medicine, King's College London, Guy's Hospital, Tower Wing, London, UK.,Breast Cancer Now Unit, School of Cancer Sciences, King's College London, Guy's Cancer Centre, London, UK
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