Resistance to BRAF-targeted therapy in melanoma

被引:293
作者
Sullivan, Ryan J. [1 ]
Flaherty, Keith T. [1 ]
机构
[1] Massachusetts Gen Hosp, Ctr Canc, Ctr Melanoma, Boston, MA 02114 USA
关键词
Melanoma; BRAF inhibitor resistance; Molecular targeted therapy; RANDOMIZED DISCONTINUATION TRIAL; INHIBITOR AZD6244 ARRY-142886; CHRONIC MYELOID-LEUKEMIA; B-RAF; PHASE-II; MULTIKINASE INHIBITOR; METASTATIC MELANOMA; OPEN-LABEL; CYCLIN D1; WILD-TYPE;
D O I
10.1016/j.ejca.2012.11.019
中图分类号
R73 [肿瘤学];
学科分类号
100214 [肿瘤学];
摘要
BRAF mutations are identified in 40-50% of patients with melanoma. Treatment of these patients with either of two BRAF inhibitors (vemurafenib, dabrafenib) or the MEK inhibitor trametinib is associated with improved clinical benefit (response rate, progression free survival, and overall survival) compared with treatment with chemotherapy in three phase III trials. Unfortunately, most patients, including those who experience initial, profound tumour regression, have evidence of disease progression within 6-8 months after commencing therapy with one of these agents. The mechanisms of resistance are varied and include activation of alternative signalling pathways as well as reactivating the MAP kinase pathway through alternative means. This review describes relevant aspects of MAP kinase pathway signalling, summarises the clinical data with BRAF and MEK inhibitors, presents the known resistance mechanisms to BRAF inhibitor therapy, and provides some strategies for how resistance may be overcome. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:1297 / 1304
页数:8
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