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V211D mutation in MEK1 causes resistance to MEK inhibitors in colon cancer

Gao Y, Maria A, Na N, da Cruz Paula A, Gorelick AN, Hechtman JF, Carson J, Lefkowitz RA, Weigelt B, Taylor BS, Zhao H, Reis-Filho JS, de Stanchina E, Rosen N, Yao Z, Yaeger R.
Cancer Discovery Sep 2019

We report the emergence of the novel MEK1 V211D gatekeeper mutation in a patient with BRAF K601E colon cancer treated with the allosteric MEK inhibitor binimetinib and the anti-EGFR antibody panitumumab. The MEK1 V211D mutation concurrently occurs in the same cell with BRAF K601E and leads to RAF-independent activity but remains regulated by RAF. The V211D mutation causes resistance to binimetinib by both increasing the catalytic activity of MEK1 and reducing its affinity for the drug. Moreover, the mutant exhibits reduced sensitivity to all the allosteric MEK inhibitors tested. Thus, this mutation serves as a general resistance mutation for current MEK inhibitors; however, it is sensitive to a newly reported ATP-competitive MEK inhibitor, which therefore could be used to overcome drug resistance. SIGNIFICANCE: We report a resistance mechanism to allosteric MEK inhibitors in the clinic. A MEK1 V211D mutation developed in a patient with BRAF K601E colon cancer on MEK and EGFR inhibitors. This mutant increases the catalytic activity of MEK1 and reduces its affinity for binimetinib, but remains sensitive to ATP-competitive MEK inhibitors.This article is highlighted in the In This Issue feature, p. 1143.



Solid Tumor

Institution Type


Indication / Modality

Colon Cancer

Goal of Study

Therapeutic Resistance, Clonal Evolution, Retrospective, Longitudinal, Tumor Profiling, Disease Modeling

Key Genes


PAD Project


Analytes Assessed

InDels, SNV

Sample Storage

Fresh Frozen

Sample Prep

Whole Cells

Sample Type

Patient Derived Xenograft

Tissue / Organ




Panel Used

Tumor Hotspot Panel

Proof Point Demonstrated

Co-occurrence, Zygosity