[PDF][PDF] Nilotinib and MEK inhibitors induce synthetic lethality through paradoxical activation of RAF in drug-resistant chronic myeloid leukemia

LM Packer, S Rana, R Hayward, T O'Hare, CA Eide… - Cancer cell, 2011 - cell.com
LM Packer, S Rana, R Hayward, T O'Hare, CA Eide, A Rebocho, S Heidorn, MS Zabriskie…
Cancer cell, 2011cell.com
We show that imatinib, nilotinib, and dasatinib possess weak off-target activity against RAF
and, therefore, drive paradoxical activation of BRAF and CRAF in a RAS-dependent
manner. Critically, because RAS is activated by BCR-ABL, in drug-resistant chronic myeloid
leukemia (CML) cells, RAS activity persists in the presence of these drugs, driving
paradoxical activation of BRAF, CRAF, MEK, and ERK, and leading to an unexpected
dependency on the pathway. Consequently, nilotinib synergizes with MEK inhibitors to kill …
Summary
We show that imatinib, nilotinib, and dasatinib possess weak off-target activity against RAF and, therefore, drive paradoxical activation of BRAF and CRAF in a RAS-dependent manner. Critically, because RAS is activated by BCR-ABL, in drug-resistant chronic myeloid leukemia (CML) cells, RAS activity persists in the presence of these drugs, driving paradoxical activation of BRAF, CRAF, MEK, and ERK, and leading to an unexpected dependency on the pathway. Consequently, nilotinib synergizes with MEK inhibitors to kill drug-resistant CML cells and block tumor growth in mice. Thus, we show that imatinib, nilotinib, and dasatinib drive paradoxical RAF/MEK/ERK pathway activation and have uncovered a synthetic lethal interaction that can be used to kill drug-resistant CML cells in vitro and in vivo.
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