Novartis Institutes for Biomedical Research, Emeryville, California 94608, USA.
Nature. 2013 Feb 14;494(7436):251-5. doi: 10.1038/nature11814. Epub 2013 Jan 9.
Mutational activation of BRAF is the most prevalent genetic alteration in human melanoma, with ≥50% of tumours expressing the BRAF(V600E) oncoprotein. Moreover, the marked tumour regression and improved survival of late-stage BRAF-mutated melanoma patients in response to treatment with vemurafenib demonstrates the essential role of oncogenic BRAF in melanoma maintenance. However, as most patients relapse with lethal drug-resistant disease, understanding and preventing mechanism(s) of resistance is critical to providing improved therapy. Here we investigate the cause and consequences of vemurafenib resistance using two independently derived primary human melanoma xenograft models in which drug resistance is selected by continuous vemurafenib administration. In one of these models, resistant tumours show continued dependency on BRAF(V600E)→MEK→ERK signalling owing to elevated BRAF(V600E) expression. Most importantly, we demonstrate that vemurafenib-resistant melanomas become drug dependent for their continued proliferation, such that cessation of drug administration leads to regression of established drug-resistant tumours. We further demonstrate that a discontinuous dosing strategy, which exploits the fitness disadvantage displayed by drug-resistant cells in the absence of the drug, forestalls the onset of lethal drug-resistant disease. These data highlight the concept that drug-resistant cells may also display drug dependency, such that altered dosing may prevent the emergence of lethal drug resistance. Such observations may contribute to sustaining the durability of the vemurafenib response with the ultimate goal of curative therapy for the subset of melanoma patients with BRAF mutations.
BRAF 基因突变是人类黑色素瘤中最常见的遗传改变,超过 50%的肿瘤表达 BRAF(V600E)癌蛋白。此外,晚期 BRAF 突变型黑色素瘤患者对vemurafenib 的治疗反应出现明显的肿瘤消退和生存改善,这证明了致癌 BRAF 在黑色素瘤维持中的重要作用。然而,由于大多数患者会复发并出现致命的耐药性疾病,因此了解和预防耐药机制对于提供改善的治疗方法至关重要。在这里,我们使用两种独立衍生的原发性人黑色素瘤异种移植模型来研究 vemurafenib 耐药的原因和后果,其中耐药性是通过连续 vemurafenib 给药选择的。在其中一种模型中,耐药肿瘤由于 BRAF(V600E)表达升高,仍然依赖 BRAF(V600E)→MEK→ERK 信号传导。最重要的是,我们证明了vemurafenib 耐药性黑色素瘤对其持续增殖具有药物依赖性,因此停止药物给药会导致已建立的耐药性肿瘤消退。我们进一步证明,间断给药策略利用了耐药细胞在没有药物的情况下显示出的适应性劣势,从而阻止了致命耐药性疾病的发生。这些数据强调了这样一种概念,即耐药细胞也可能表现出药物依赖性,因此改变给药方式可能会防止致命耐药性的出现。这些观察结果可能有助于维持 vemurafenib 反应的持久性,最终目标是为携带 BRAF 突变的黑色素瘤患者亚组提供治愈性治疗。
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