Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy.
Department of Oncology, University of Torino, San Luigi Hospital, Orbassano, Italy.
Mol Oncol. 2024 Jun;18(6):1355-1377. doi: 10.1002/1878-0261.13605. Epub 2024 Feb 16.
Mutations in the RAS-RAF-MEK-ERK pathway are frequent alterations in cancer and RASopathies, and while RAS oncogene activation alone affects 19% of all patients and accounts for approximately 3.4 million new cases every year, less frequent alterations in the cascade's downstream effectors are also involved in cancer etiology. RAS proteins initiate the signaling cascade by promoting the dimerization of RAF kinases, which can act as oncoproteins as well: BRAF is the most common oncogenic driver, mutated in the 8% of all malignancies. Research in this field led to the development of drugs that target the BRAFV600-like mutations (Class I), which are now utilized in clinics, but cause paradoxical activation of the pathway and resistance development. Furthermore, they are ineffective against non-BRAFV600E malignancies that dimerize and could be either RTK/RAS independent or dependent (Class II and III, respectively), which are still lacking an effective treatment. This review discusses the recent advances in anti-RAF therapies, including paradox breakers, dimer-inhibitors, immunotherapies, and other novel approaches, critically evaluating their efficacy in overcoming the therapeutic limitations, and their putative role in blocking the RAS pathway.
RAS-RAF-MEK-ERK 通路中的突变是癌症和 RAS 病的常见改变,虽然 RAS 癌基因的单独激活影响所有患者的 19%,并导致每年约 340 万新病例,但该级联下游效应物中较不常见的改变也与癌症病因有关。RAS 蛋白通过促进 RAF 激酶的二聚化来启动信号级联,RAF 激酶本身也可以作为癌蛋白发挥作用:BRAF 是最常见的致癌驱动基因,在所有恶性肿瘤的 8%中发生突变。该领域的研究导致了针对 BRAFV600 样突变(I 类)的药物的开发,这些药物现在已经在临床上使用,但会导致该通路的反常激活和耐药性的产生。此外,它们对非 BRAFV600E 肿瘤无效,这些肿瘤可以二聚化,并且可以是 RTK/RAS 独立的或依赖的(分别为 II 类和 III 类),这些肿瘤仍然缺乏有效的治疗方法。本文综述了抗 RAF 治疗的最新进展,包括反常抑制剂、二聚抑制剂、免疫疗法和其他新方法,批判性地评估了它们在克服治疗限制方面的疗效,以及它们在阻断 RAS 通路方面的潜在作用。