MEK interactions tune RAF kinase sensitivity to conformation-selective inhibition

RAF kinases are key effectors in the RAS-RAF-MEK-ERK signaling pathway, making them important targets for the development of cancer therapeutics. Here we investigate the variable potency of DFG-out-stabilizing RAF inhibitors in mutant KRAS-expressing cell lines. We demonstrate that inhibitor potency correlates with basal RAF activity, with more active RAF being more sensitive to inhibition. We further show that DFG-out-stabilizing inhibitors disrupt high-affinity RAF-MEK interactions, promoting the formation of inhibited RAF dimers. Furthermore, we identify cobimetinib as an MEK inhibitor that uniquely sensitizes RAF kinases to DFG-out-stabilizing inhibitors by disrupting autoinhibited RAF-MEK complexes. Building on this insight, we developed cobimetinib analogs with enhanced sensitization properties. Together, our findings provide a mechanistic framework for understanding the cellular determinants of DFG-out-stabilizing inhibitor sensitivity and offer strategies for optimizing synergistic RAF-MEK inhibitor combinations.