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    Oncotarget. pii: 12848. doi: 10.18632/oncotarget.12848
    Co-existence of BRAF and NRAS driver mutations in the same melanoma cells results in heterogeneity of targeted therapy resistance.
    Raaijmakers MI1,  Widmer DS2,  Narechania A3,  Eichhoff O4,  Freiberger SN5,  Wenzina J6,  Cheng PF7,  Mihic-Probst D8,  Desalle R9,  Dummer R10,  Levesque MP11
    Author information
    1Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    2Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    3American Museum of Natural History, New York, New York, USA.
    4Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    5Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    6Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    7Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    8Department of Pathology, University of Zurich, University Hospital Zürich, Switzerland.
    9American Museum of Natural History, New York, New York, USA.
    10Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    11Department of Dermatology, University of Zurich, University Hospital Zürich, Switzerland.
    Abstract

    Acquired chemotherapeutic resistance of cancer cells can result from a Darwinistic evolution process in which heterogeneity plays an important role. In order to understand the impact of genetic heterogeneity on acquired resistance and second line therapy selection in metastatic melanoma, we sequenced the exomes of 27 lesions which were collected from 3 metastatic melanoma patients treated with targeted or non-targeted inhibitors. Furthermore, we tested the impact of a second NRAS mutation in 7 BRAF inhibitor resistant early passage cell cultures on the selection of second line therapies.We observed a rapid monophyletic evolution of melanoma subpopulations in response to targeted therapy that was not observed in non-targeted therapy. We observed the acquisition of NRAS mutations in the BRAF mutated patient treated with a BRAF inhibitor in 1 of 5 of his post-resistant samples. In an additional cohort of 5 BRAF-inhibitor treated patients we detected 7 NRAS mutations in 18 post-resistant samples. No NRAS mutations were detected in pre-resistant samples. By sequencing 65 single cell clones we prove that NRAS mutations co-occur with BRAF mutations in single cells. The double mutated cells revealed a heterogeneous response to MEK, ERK, PI3K, AKT and multi RTK - inhibitors.We conclude that BRAF and NRAS co-mutations are not mutually exclusive. However, the sole finding of double mutated cells in a resistant tumor is not sufficient to determine follow-up therapy. In order to target the large pool of heterogeneous cells in a patient, we think combinational therapy targeting different pathways will be necessary.


    KEYWORDS: MAPK pathway, heterogeneity, melanoma, mutation, targeted therapy resistance

    Publikations ID: 27791198
    Quelle: öffnen
     
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