Abstract
EGFR mutations account for the majority of druggable targets in lung adenocarcinoma. Over the past decades the optimization of EGFR inhibitors revolutionized the treatment options for patients suffering from this disease. The pace of this development was largely dictated by the inevitable emergence of resistance mutations during drug treatment. As a result, a rapid understanding of the structural and molecular biology of the individual mutations is the key for the development of next-generation inhibitors. Currently, the field faces an unprecedented number of combinations of activating mutations with distinct resistance mutations in parallel to the approval of osimertinib as a first-line drug for EGFR-mutant lung cancer. In this review, we present a survey of the diverse landscape of EGFR resistance mechanisms with a focus on new insights into on-target EGFR kinase mutations. We discuss array of mutations, their structural effects on the EGFR kinase domain as well as the most promising strategies to overcome the individual resistance profiles found in lung cancer patients.
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Acknowledgements
We thank all members of the Sos Lab for fruitful comments, especially Johannes Brägelmann and Katia Garbert. This work was supported by the Bundesministerium für Bildung und Forschung (e:Med initative; 01ZX1901A), a research grant by the Thyssen Foundation (10.19.2.025MN), the German Research Foundation (DFG) within the collaborative research center 1399 and the Deutsche Krebshilfe (70112888).
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MLS is a founder and shareholder of PearlRiver Bio GmbH and receives a research grant from PearlRiver Bio GmbH. HLT is a consultant for PearlRiver Bio GmbH.
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Tumbrink, H.L., Heimsoeth, A. & Sos, M.L. The next tier of EGFR resistance mutations in lung cancer. Oncogene 40, 1–11 (2021). https://doi.org/10.1038/s41388-020-01510-w
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DOI: https://doi.org/10.1038/s41388-020-01510-w
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