Soft tissue sarcomas (STS) are a heterogenous group of cancers. They account for 1% of all cancers. Approximately 9,000 new cases are diagnosed in the United States each year (
1). Clinically, approximately 50% of people with sarcomas will die of their disease. Surgery and radiation therapy are the principal means to achieve tumor control. Adjuvant chemotherapy has been examined and is used for sarcomas typically occurring in children and young adults (osteogenic sarcoma, Ewing sarcoma, and rhabdomyosarcoma, e.g.) but is of marginal, if any, benefit for the types of sarcomas more commonly encountered in adults (liposarcomas, leiomyosarcoma, malignant fibrous histiocytoma, e.g.). In the metastatic setting, doxorubicin and ifosfamide have remained the best drugs for 20 or more years but these remain essentially palliative with substantial toxicity. Thus, there is an unmet need to identify and test promising new agents in the metastatic setting.
Receptor tyrosine kinase inhibition has been shown to be a remarkably effective mechanism to treat hematopoietic, epithelial, and mesenchymal cancers (
2). The remarkable results with imatinib for metastatic gastrointestinal stromal tumor (GIST) give hope that targeted therapy will be beneficial for some of the other 50 or more subtypes of sarcoma (
3). As a result, we have begun a broad based search for small molecule organic compounds to target tyrosine- and serine/threonine kinases critical to the survival of STS cells. One such screen yielded sorafenib, a compound with preclinical evidence of inhibition of B-Raf kinase, VEGFR2, and other kinases (
4). The Raf family of serine/threonine kinases compromises three members: C-Raf (Raf-1), A-Raf, and B-Raf. The activation of the Raf kinases proceeds through binding to activated Ras. Once activated, all the Raf kinases can phosphorylate MEK, which in turn phosphorylates and activates ERK (
5). Activation of the Mitogen-Activated Protein Kinase (MAPK) pathway results in the transcriptional induction of Cyclin D1 with activation of CDK4, phosphorylation of pRb and continued cell cycle progression from G1 to S (
5,
6).
Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue tumors with a very poor prognosis (
7–
9). MPNSTs are particularly intriguing targets for sorafenib given the activation of the ras pathway by loss of tumor suppressor neurofibromatosis type I (NF1) in the majority of familial and sporadic MPNST. NF1 is an autosomal dominant disorder, effecting 1 in 3000 people worldwide that ultimately can lead to MPNSTs (
7). Surgical specimens and cell lines from patients with spontaneous MPNST or MPNST arising in the setting of neurofibromatosis show high levels of ras activity (
7–
10). NF1 gene transcribes neurofibromin, a protein that negatively regulates Ras proteins (
11). Loss of neurofibromin is associated with increase in Ras activity resulting in an increase in the activation of the MAPK pathway (
7,
11,
12).
Raf was the first effector kinase identified which is downstream of Ras (
13). The activation of Raf occurs after recruitment to the membrane and its association with active or GTP-Ras (
14). Although oncogenic forms of all the Rafs can be experimentally induced, the B-Raf form has exclusively been identified in somatic cells (
15). Additionally, B-Raf has greater activity towards targeting MEK than C-Raf or A-Raf (
6). Since B-Raf has only two sites for activation, S598 and T601, it only requires one substitution for activation, V599E, now known as V600E (
15). The V600E missense mutation, basis for 80% of the oncogenic B-Raf alleles, results in maximal activity of native B-Raf, probably by mimicking the inherent phosphorylation of S598 and T601 by Ras (
15). Mutations that occur in cancer activate B-Raf from 1.3- to 700-fold relative to wild-type B-Raf, as shown by their abilities to phosphorylate MEK in vitro and stimulate ERK signaling in vivo (
16). These high activity mutants render tumor cells sensitive to sorafenib therapy (
17).
Sorafenib has been characterized and studied in tumor cell lines with hyperactivating B-Raf mutations. As indicated in a screen for mutations in this oncogene among a wide variety of cancers, B-Raf mutations are rare in STS and only one malignant fibrous histiocytoma (MFH) was shown to have a mutation in B-Raf (
18). Little is known of the effects of sorafenib on MPNST cells, which have activated B-Raf by virtue of a decrease in NF1 expression and activation of the Ras signaling cascade. Therefore, we elected to test sorafenib against our series of sarcoma cell lines including those derived from patients with MPNST and to correlate sensitivity to inhibition of MAPK activity.