Targeting hyperactivation of the AKT survival pathway to overcome therapy resistance of melanoma brain metastases

Cancer Med. 2013 Feb;2(1):76-85. doi: 10.1002/cam4.50. Epub 2013 Feb 3.


Brain metastases are the most common cause of death in patients with metastatic melanoma, and the RAF-MEK-ERK and PI3K-AKT signaling pathways are key players in melanoma progression and drug resistance. The BRAF inhibitor vemurafenib significantly improved overall survival. However, brain metastases still limit the effectiveness of this therapy. In a series of patients, we observed that treatment with vemurafenib resulted in substantial regression of extracerebral metastases, but brain metastases developed. This study aimed to identify factors that contribute to treatment resistance in brain metastases. Matched brain and extracerebral metastases from melanoma patients had identical ERK, p-ERK, and AKT immunohistochemistry staining patterns, but there was hyperactivation of AKT (p-AKT) and loss of PTEN expression in the brain metastases. Mutation analysis revealed no differences in BRAF, NRAS, or KIT mutation status in matched brain and extracerebral metastases. In contrast, AKT, p-AKT, and PTEN expression was identical in monolayer cultures derived from melanoma brain and extracerebral metastases. Furthermore, melanoma cells stimulated by astrocyte-conditioned medium showed higher AKT activation and invasiveness than melanoma cells stimulated by fibroblast-conditioned medium. Inhibition of PI3K-AKT signaling resensitized melanoma cells isolated from a vemurafenib-resistant brain metastasis to vemurafenib. Brain-derived factors appear to induce hyperactivation of the AKT survival pathway and to promote the survival and drug resistance of melanoma cells in the brain. Thus, inhibition of PI3K-AKT signaling shows potential for enhancing and/or prolonging the antitumor effect of BRAF inhibitors or other anticancer agents in melanoma brain metastases.

Keywords: AKT; BRAF inhibitors; brain metastasis; melanoma; therapy resistance.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / pharmacology
  • Antineoplastic Agents / therapeutic use
  • Astrocytes / metabolism
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / drug therapy
  • Brain Neoplasms / genetics
  • Brain Neoplasms / pathology
  • Brain Neoplasms / secondary*
  • Culture Media, Conditioned / pharmacology
  • DNA Mutational Analysis / methods
  • Drug Resistance, Neoplasm / drug effects
  • Drug Resistance, Neoplasm / genetics*
  • Enzyme Inhibitors / pharmacology
  • GTP Phosphohydrolases / genetics
  • Humans
  • Indoles / pharmacology
  • Indoles / therapeutic use
  • Male
  • Melanoma / diagnostic imaging
  • Melanoma / drug therapy
  • Melanoma / genetics
  • Melanoma / pathology
  • Melanoma / secondary*
  • Membrane Proteins / genetics
  • Middle Aged
  • Mutation
  • Neoplasm Invasiveness
  • Phosphoinositide-3 Kinase Inhibitors
  • Proto-Oncogene Proteins B-raf / antagonists & inhibitors
  • Proto-Oncogene Proteins B-raf / genetics
  • Proto-Oncogene Proteins c-akt / biosynthesis
  • Proto-Oncogene Proteins c-akt / genetics*
  • Proto-Oncogene Proteins c-kit / genetics
  • Signal Transduction / genetics
  • Sulfonamides / pharmacology
  • Sulfonamides / therapeutic use
  • Tomography, X-Ray Computed
  • Tumor Cells, Cultured
  • Vemurafenib


  • Antineoplastic Agents
  • Culture Media, Conditioned
  • Enzyme Inhibitors
  • Indoles
  • Membrane Proteins
  • Phosphoinositide-3 Kinase Inhibitors
  • Sulfonamides
  • Vemurafenib
  • Proto-Oncogene Proteins c-kit
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf
  • Proto-Oncogene Proteins c-akt
  • GTP Phosphohydrolases
  • NRAS protein, human