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 cell-cycle 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.