Dual inhibition of BRAF and mTOR in BRAF V600E -mutant pediatric, adolescent, and young adult brain tumors

Shiraj Sen, Ryuma Tanaka, Soumen Khatua, Wafik Zaky, Filip Janku, Marta Penas-Prado, Shiao-Pei Weathers, Amini Behrang, Jason Roszik, Vivek Subbiah
Cold Spring Harbor Molecular Case Studies 2020, 6 (4)
Although BRAF inhibition has demonstrated activity in BRAF V600 -mutated brain tumors, ultimately these cancers grow resistant to BRAF inhibitor monotherapy. Parallel activation of the phosphatidylinositol 3-kinase-mammalian target of rapamycin pathway has been implicated as a mechanism of primary and secondary resistance to BRAF inhibition. Moreover, it has been shown specifically that mTOR signaling activation occurs in BRAF-mutant brain tumors. We therefore conducted phase 1 trials combining vemurafenib with everolimus, enrolling five pediatric and young adults with BRAF V600 -mutated brain tumors. None of the patients required treatment discontinuation as a result of adverse events. Overall, two patients (40%) had a partial response and one (20%) had 12 mo of stable disease as best response. Co-targeting BRAF and mTOR in molecularly selected brain cancers should be further investigated.

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