Overcoming resistance to BRAF inhibition in BRAF-mutated metastatic melanoma

Oncotarget. 2014 Nov 15;5(21):10206-21. doi: 10.18632/oncotarget.2602.

Abstract

Almost 50% of metastatic melanoma patients harbor a BRAF(V600) mutation and the introduction of BRAF inhibitors has improved their treatment options. BRAF inhibitors vemurafenib and dabrafenib achieved improved overall survival over chemotherapy and have been approved for the treatment of BRAF-mutated metastatic melanoma. However, most patients develop mechanisms of acquired resistance and about 15% of them do not achieve tumor regression at all, due to intrinsic resistance to therapy. Moreover, early adaptive responses limit the initial efficacy of BRAF inhibition, leading mostly to incomplete responses that may favor the selection of a sub-population of resistant clones and the acquisition of alterations that cause tumor regrowth and progressive disease. The purpose of this paper is to review the mechanisms of resistance to therapy with BRAF inhibitors and to discuss the strategies to overcome them based on pre-clinical and clinical evidences.

Publication types

  • Review

MeSH terms

  • Animals
  • Clinical Trials as Topic
  • Drug Evaluation, Preclinical
  • Drug Resistance, Neoplasm
  • Humans
  • Imidazoles / pharmacology
  • Imidazoles / therapeutic use*
  • Indoles / pharmacology
  • Indoles / therapeutic use*
  • Melanoma / drug therapy*
  • Melanoma / genetics
  • Melanoma / mortality
  • Neoplasm Metastasis
  • Oximes / pharmacology
  • Oximes / therapeutic use*
  • Proto-Oncogene Proteins B-raf / antagonists & inhibitors
  • Proto-Oncogene Proteins B-raf / genetics*
  • Recurrence
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / genetics
  • Skin Neoplasms / mortality
  • Sulfonamides / pharmacology
  • Sulfonamides / therapeutic use*
  • Vemurafenib

Substances

  • Imidazoles
  • Indoles
  • Oximes
  • Sulfonamides
  • Vemurafenib
  • Proto-Oncogene Proteins B-raf
  • dabrafenib