Abstract C174: RAF kinase dimerization mediates clinical acquired resistance to RAF/EGFR inhibition in BRAF V600E colorectal cancer

Abstract

Abstract Background: RAF and EGFR inhibitor combinations have shown promising clinical activity in patients with BRAF V600E colorectal cancer, but resistance invariably develops. Methods: To define mechanisms of resistance to RAF/EGFR inhibition, we analyzed pre-treatment and disease progression samples from patients with BRAF mutant colorectal cancer using our custom next-generation sequencing platform, MSK-IMPACT (Integrated Mutation Profiling of Actionable Cancer Targets). Cell line and patient derived xenograft models were generated to investigate the effects of the genetic alterations identified at disease progression. Results: We identified alterations predicted to result in RAF dimerization and re-activation of ERK signaling in seven of eight post-progression tumors. These alterations included an intragenic deletion in BRAF encompassing the RAS binding domain, KRAS and NRAS mutations, and KRAS, NRAS, and BRAF amplifications. Notably, these alterations were rapidly enriched in the presence of drug treatment but selected against in the absence of drug exposure. A novel RAF inhibitor, that equipotently inhibits RAF mutant monomers and dimers, effectively suppressed ERK signaling in the RAF/EGFR resistant colorectal tumors at drug doses that did not inhibit ERK signaling in RAS/RAF wild-type cells. Treatment with this novel RAF inhibitor was able to overcome resistance in cell line and patient derived xenograft models. Conclusions: Our data suggest that alterations that promote RAF dimers, which are resistant to first generation RAF inhibitors, are a unifying mechanism of RAF/EGFR inhibitor resistance in patients with BRAF mutant colorectal cancer. These results support the testing of RAF dimer inhibitors in combination with EGFR inhibitors in patients with BRAF V600E colorectal cancer. Citation Format: Rona Yaeger, Zhan Yao, David M. Hyman, Jaclyn F. Hechtman, Efsevia Vakiani, Andrea Cercek, Jose Baselga, Elisa DeStanchina, Leonard Saltz, Michael F. Berger, David B. Solit, Neal Rosen. RAF kinase dimerization mediates clinical acquired resistance to RAF/EGFR inhibition in BRAF V600E colorectal cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr C174.