KRAS G12C 突变型非小细胞肺癌:生物学、研发治疗策略和分子检测。

KRAS G12C-Mutant Non-Small Cell Lung Cancer: Biology, Developmental Therapeutics, and Molecular Testing.

机构信息

Icahn School of Medicine, The Mount Sinai Hospital, New York, New York.

Amgen Inc., Thousand Oaks, California.

出版信息

J Mol Diagn. 2021 May;23(5):507-520. doi: 10.1016/j.jmoldx.2021.02.002. Epub 2021 Feb 20.

Abstract

Mutation in the gene that encodes Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most common oncogenic driver in advanced non-small cell lung cancer, occurring in approximately 30% of lung adenocarcinomas. Over 80% of oncogenic KRAS mutations occur at codon 12, where the glycine residue is substituted by different amino acids, leading to genomic heterogeneity of KRas-mutant tumors. The KRAS glycine-to-cysteine mutation (G12C) composes approximately 44% of KRAS mutations in non-small cell lung cancer, with mutant KRas present in approximately 13% of all patients with lung adenocarcinoma. Mutant KRas has been an oncogenic target for decades, but no viable therapeutic agents were developed until recently. However, advances in KRas molecular modeling have led to the development and clinical testing of agents that directly inhibit mutant KRas. These agents include sotorasib (AMG-510), adagrasib (MRTX-849), and JNJ-74699157. In addition to testing for known actionable oncogenic driver alterations in EGFR, ALK, ROS1, BRAF, MET exon 14 skipping, RET, and NTRK and for the expression of programmed cell-death protein ligand 1, pathologists, medical oncologists, and community practitioners will need to incorporate routine testing for emerging biomarkers such as MET amplification, ERBB2 (alias HER2), and KRAS mutations, particularly KRAS G12C, considering the promising development of direct inhibitors of KRas protein.

摘要

基因编码 Kirsten 大鼠肉瘤病毒致癌基因同源物(KRAS)的突变是晚期非小细胞肺癌中最常见的致癌驱动因素,约发生于 30%的肺腺癌中。超过 80%的致癌 KRAS 突变发生在密码子 12,甘氨酸残基被不同的氨基酸取代,导致 KRas 突变肿瘤的基因组异质性。KRAS 甘氨酸到半胱氨酸突变(G12C)构成非小细胞肺癌中 KRAS 突变的约 44%,在所有肺腺癌患者中,约有 13%存在突变 KRas。KRas 突变已成为致癌靶点数十年,但直到最近才开发出可行的治疗药物。然而,KRas 分子建模的进展导致了直接抑制突变 KRas 的药物的开发和临床测试。这些药物包括索托拉西布(AMG-510)、阿达格拉西布(MRTX-849)和 JNJ-74699157。除了测试 EGFR、ALK、ROS1、BRAF、MET 外显子 14 跳跃、RET 和 NTRK 中已知的可操作致癌驱动因素改变以及程序性细胞死亡蛋白配体 1 的表达外,病理学家、肿瘤内科医生和社区医生还需要将新兴生物标志物(如 MET 扩增、ERBB2(别名 HER2)和 KRAS 突变,特别是 KRAS G12C)的常规检测纳入常规检测中,考虑到 KRas 蛋白的直接抑制剂的有前景的开发。

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