B-RAF is mutated to a constitutively active form in 8% of human cancers including 50% of melanomas. In clinical trials, the RAF inhibitor, PLX4032 (vemurafenib), caused partial or complete responses in 48-81% of mutant B-RAF harboring melanoma patients. However, the average duration of response was 6-7 months before tumor regrowth, indicating the acquisition of resistance to PLX4032. To understand the mechanisms of resistance, we developed mutant B-RAF melanoma cells that displayed resistance to RAF inhibition through continuous culture with PLX4720 (the tool compound for PLX4032). Resistance was associated with a partial reactivation of extracellular signal-regulated kinase 1/2 (ERK1/2) signaling, recovery of G1/S cellcycle events, and suppression of the pro-apoptotic B-cell leukemia/lymphoma 2 (Bcl-2) homology domain 3 (BH3)-only proteins, Bcl-2-interacting mediator of cell death-extra large (Bim-EL) and Bcl-2 modifying factor (Bmf). Preventing ERK1/2 reactivation with MEK (mitogen-activated protein/extracellular signal-regulated kinase kinase) inhibitors blocked G1-S cell-cycle progression but failed to induce apoptosis or upregulate Bim-EL and Bmf. Treatment with the histone deacetylase (HDAC) inhibitor, suberoylanilide hydroxamic acid, led to de-repression of Bim-EL and enhanced cell death in the presence of PLX4720 or AZD6244 in resistant cells. These data indicate that acquired resistance to PLX4032/4720 likely involves ERK1/2 pathway reactivation as well as ERK1/2-independent silencing of BH3-only proteins. Furthermore, combined treatment of HDAC inhibitors and MEK inhibitors may contribute to overcoming PLX4032 resistance. Oncogene addiction refers to the dependence of tumor cells on the continued expression of an oncogene for the maintenance of malignant properties.1 It has gained increasing recognition in recent years and provides the rationale for targeted therapeutic strategies. Notable advances are the responses of chronic myelogenous leukemia patients with BCR-ABL (breakpoint cluster region-v-abl abelson murine leukemia viral oncogene homolog 1) translocations to imatinib, breast cancer patients with amplified human epidermal receptor 2 (HER2) to trastuzumab, and mutant epidermal growth factor receptor (EGFR)-harboring nonsmall cell lung carcinomas patients to erlotinib and gefitinib treatments.2-4 A more recent example is the strategy to target mutations in the serine/threonine kinase B-RAF that occur in B50% of melanomas, 30% of thyroid carcinomas, and 14% of colorectal tumors.5 A valine to glutamic acid substitution at codon 600 (V600E) accounts for over 90% of the mutations in B-RAF and activates B-RAF kinase activity toward the MEKextracellular signal-regulated kinase 1/2 (ERK1/2) cascade.
B-RAFV600E and MEK (mitogen-activated protein/extracellular signal-regulated kinase kinase) activity are required for melanoma cell proliferation, invasion, and resistance to apoptosis in vitro, 6-11 and tumor xenograft growth in immunocompromised mice. 8,12 Furthermore, conditional melanocyte-specific expr...