BACKGROUND: The high prevalence of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) and neuroblastoma v-ras oncogene homolog (NRAS) mutations in melanoma provides a strong rationale to test the clinical efficacy of mitogen-activated protein kinase kinase (MEK) inhibition in this disease. The authors hypothesized that the presence of BRAF or NRAS mutations would correlate with clinical benefit among patients who received treatment with combination regimens that included the MEK inhibitor selumetinib. METHODS: BRAF and NRAS mutation status was determined retrospectively in available tissue specimens from patients with melanoma who were enrolled in a phase 1 trial of selumetinib in combination with 1 of 4 drugs (dacarbazine, docetaxel, temsirolimus, or erlotinib). The clinical response rate and the time to progression (TTP) were assessed as a function of BRAF and NRAS mutation status. RESULTS: Among 18 patients analyzed, 9 patients (50%) harbored a BRAF mutation (8 had a valine-to-glutamic acid substitution at residue 600 [V600E]; 1 had an arginine nonsense mutation at residue 603 [R603]), 4 patients (22%) harbored an NRAS mutation (2 had a glutamine-to-arginine substitution at residue 61 [Q61R], 1 had a glutamine-to-lysine substitution at residue 61 [Q61K], and 1 had a glycine-to-lysine substitution at residue 12 [G12S]), and 5 patient (28%) had the wild type of both genes. These mutations were mutually exclusive. Among the 9 patients who had BRAF mutations, 5 patients (56%) achieved a partial response, and 4 patients (44%) achieved stable disease for at least 6 weeks. No patient with the wild-type BRAF gene achieved a clinical response (P = .01 vs patients with BRAF mutations). The presence of an NRAS mutation did not correlate with the clinical response rate. The presence of a BRAF mutation was correlated significantly with the TTP in a multivariate model (hazard ratio, 0.22; P = .02 vs wild-type BRAF). CONCLUSIONS: Higher response rates and longer TTP were observed with selumetinib-containing regimens in patients who had tumors that harbored a BRAF mutation compared with patients who had wild-type BRAF.
BACKGROUND: The high prevalence of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) and neuroblastoma v-ras oncogene homolog (NRAS) mutations in melanoma provides a strong rationale to test the clinical efficacy of mitogen-activated protein kinase kinase (MEK) inhibition in this disease. The authors hypothesized that the presence of BRAF or NRAS mutations would correlate with clinical benefit among patients who received treatment with combination regimens that included the MEK inhibitor selumetinib. METHODS:BRAF and NRAS mutation status was determined retrospectively in available tissue specimens from patients with melanoma who were enrolled in a phase 1 trial of selumetinib in combination with 1 of 4 drugs (dacarbazine, docetaxel, temsirolimus, or erlotinib). The clinical response rate and the time to progression (TTP) were assessed as a function of BRAF and NRAS mutation status. RESULTS: Among 18 patients analyzed, 9 patients (50%) harbored a BRAF mutation (8 had a valine-to-glutamic acid substitution at residue 600 [V600E]; 1 had an arginine nonsense mutation at residue 603 [R603]), 4 patients (22%) harbored an NRAS mutation (2 had a glutamine-to-arginine substitution at residue 61 [Q61R], 1 had a glutamine-to-lysine substitution at residue 61 [Q61K], and 1 had a glycine-to-lysine substitution at residue 12 [G12S]), and 5 patient (28%) had the wild type of both genes. These mutations were mutually exclusive. Among the 9 patients who had BRAF mutations, 5 patients (56%) achieved a partial response, and 4 patients (44%) achieved stable disease for at least 6 weeks. No patient with the wild-type BRAF gene achieved a clinical response (P = .01 vs patients with BRAF mutations). The presence of an NRAS mutation did not correlate with the clinical response rate. The presence of a BRAF mutation was correlated significantly with the TTP in a multivariate model (hazard ratio, 0.22; P = .02 vs wild-type BRAF). CONCLUSIONS: Higher response rates and longer TTP were observed with selumetinib-containing regimens in patients who had tumors that harbored a BRAF mutation compared with patients who had wild-type BRAF.
Authors: Bert H O'Neil; Laura W Goff; John Sae Wook Kauh; Jonathan R Strosberg; Tanios S Bekaii-Saab; Ruey-Min Lee; Aslamuzzaman Kazi; Dominic T Moore; Maria Learoyd; Richard M Lush; Said M Sebti; Daniel M Sullivan Journal: J Clin Oncol Date: 2011-04-25 Impact factor: 44.544
Authors: Nitin Jain; Emily Curran; Neil M Iyengar; Ernesto Diaz-Flores; Rangesh Kunnavakkam; Leslie Popplewell; Mark H Kirschbaum; Theodore Karrison; Harry P Erba; Margaret Green; Xavier Poire; Greg Koval; Kevin Shannon; Poluru L Reddy; Loren Joseph; Ehab L Atallah; Philip Dy; Sachdev P Thomas; Scott E Smith; L Austin Doyle; Walter M Stadler; Richard A Larson; Wendy Stock; Olatoyosi Odenike Journal: Clin Cancer Res Date: 2013-10-31 Impact factor: 12.531
Authors: Paul K Paik; Maria E Arcila; Michael Fara; Camelia S Sima; Vincent A Miller; Mark G Kris; Marc Ladanyi; Gregory J Riely Journal: J Clin Oncol Date: 2011-04-11 Impact factor: 44.544
Authors: Federica Catalanotti; David B Solit; Melissa P Pulitzer; Michael F Berger; Sasinya N Scott; Tunc Iyriboz; Mario E Lacouture; Katherine S Panageas; Jedd D Wolchok; Richard D Carvajal; Gary K Schwartz; Neal Rosen; Paul B Chapman Journal: Clin Cancer Res Date: 2013-02-26 Impact factor: 12.531
Authors: Moriah H Nissan; Christine A Pratilas; Alexis M Jones; Ricardo Ramirez; Helen Won; Cailian Liu; Shakuntala Tiwari; Li Kong; Aphrothiti J Hanrahan; Zhan Yao; Taha Merghoub; Antoni Ribas; Paul B Chapman; Rona Yaeger; Barry S Taylor; Nikolaus Schultz; Michael F Berger; Neal Rosen; David B Solit Journal: Cancer Res Date: 2014-02-27 Impact factor: 12.701