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Review
. 2021 Feb 22:13:1758835921992974.
doi: 10.1177/1758835921992974. eCollection 2021.

BRAF, MEK and EGFR inhibition as treatment strategies in BRAF V600E metastatic colorectal cancer

Javier Ros  1 , Iosune Baraibar  2 , Emilia Sardo  2 , Nuria Mulet  3 , Francesc Salvà  2 , Guillem Argilés  2 , Giulia Martini  3 , Davide Ciardiello  3 , José Luis Cuadra  4 , Josep Tabernero  5 , Elena Élez  2
Affiliations
Review

BRAF, MEK and EGFR inhibition as treatment strategies in BRAF V600E metastatic colorectal cancer

Javier Ros et al. Ther Adv Med Oncol. .

Abstract

Introduction: BRAF driver mutations are found in up to 15% of patients with colorectal cancer (CRC) and lead to constitutive activation of BRAF kinase and sustained RAS/RAF/MEK/ERK pathway signaling. BRAF mutations define a sub-population characterized by a poor prognosis and dismal median survival. Following successful outcomes with BRAF inhibition in BRAF mutant metastatic melanoma, this approach was evaluated in metastatic colorectal cancer (mCRC). The development and combination of targeted therapies against multiple signaling pathways has proved particularly successful, with improved survival and response rates.

Areas covered: This review addresses the development of therapeutic strategies with inhibitors targeting MAPK/ERK and EGFR signaling in BRAF V600E mutated mCRC, focusing on encorafenib, binimetinib and cetuximab. A pharmacological and clinical review of these drugs and the therapeutic approaches behind their optimization are presented.

Expert opinion: Exploiting knowledge of the mechanisms of resistance to BRAF inhibitors has been crucial to developing effective therapeutic strategies in BRAF-V600E mutant mCRC. The BEACON trial is a successful example of this approach, using encorafenib and cetuximab with or without binimetinib in patients with previously treated BRAF V600E mutant mCRC, showing an impressive improvement in clinical outcomes and tolerable toxicity compared with chemotherapy, establishing a new standard of care in this setting.

Keywords: BEACON clinical trial; BRAF V600E mutation; BRAF inhibitor; EGFR inhibitor; MEK inhibitor; binimetinib; colon cancer; encorafenib.

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Conflict of interest statement

Conflict of interest statement: E. Élez declares personal financial interests, honoraria for advisory role, travel grants, research grants (past 5 years) from: Hoffman La-Roche, Sanofi Aventis, Amgen, Merck Serono, Servier, MSD, Array Pharmaceuticals, Bristol-Myers Squibb. E. Élez also declares institutional financial interests – the institution received honoraria due to their investigator contribution in clinical trials from: Hoffman LaRoche, Sanofi Aventis, Amgen, Merck Serono, MSD, Boehringer Ingelheim, AbbVie, Array Pharmaceuticals, Pierre-Fabre, Novartis, Bristol-Myers Squibb, GlaxoSmithKline, Medimmune. E. Elez is awarded with a PERIS fellowship from the Departament de Salut, Generalitat de Catalunya [SLT008/18/00198]. J. Ros declares honoraria from Sanofi. Travel, accommodations, expenses: Amgen. G. Argilés declares consulting and advisory roles for Roche, Bristol-Myers Squibb, Genentech/Roche, Bayer, Servier. Travel, accommodations, expenses: Bayer, Roche, Amgen, Servier. JL Cuadra-Urteaga declares an advisory role, travel grants from Hoffman La-Roche, Amgen, Merck Serono, Lilly, Sanofi. D. Ciardiello declares travel, accommodations, expenses from Sanofi. J. Tabernero declares personal financial interest in form of scientific consultancy role for Array Biopharma, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Chugai, Genentech, Inc., Genmab A/S, Halozyme, Imugene Limited, Inflection Biosciences Limited, Ipsen, Kura Oncology, Lilly, MSD, Menarini, Merck Serono, Merrimack, Merus, Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd., Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS and Roche Diagnostics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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