Division of Hematology and Medical Oncology, Department of Medicine, Laura and Isaac Perlmutter Cancer Center, New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, NY, USA.
Nat Rev Clin Oncol. 2022 Oct;19(10):637-655. doi: 10.1038/s41571-022-00671-9. Epub 2022 Aug 26.
Despite being the most frequently altered oncogenic protein in solid tumours, KRAS has historically been considered 'undruggable' owing to a lack of pharmacologically targetable pockets within the mutant isoforms. However, improvements in drug design have culminated in the development of inhibitors that are selective for mutant KRAS in its active or inactive state. Some of these inhibitors have proven efficacy in patients with KRAS-mutant cancers and have become practice changing. The excitement associated with these advances has been tempered by drug resistance, which limits the depth and/or duration of responses to these agents. Improvements in our understanding of RAS signalling in cancer cells and in the tumour microenvironment suggest the potential for several novel combination therapies, which are now being explored in clinical trials. Herein, we provide an overview of the RAS pathway and review the development and current status of therapeutic strategies for targeting oncogenic RAS, as well as their potential to improve outcomes in patients with RAS-mutant malignancies. We then discuss challenges presented by resistance mechanisms and strategies by which they could potentially be overcome.
尽管 KRAS 是实体瘤中最常被改变的致癌蛋白,但由于突变体亚型中缺乏药理学上可靶向的口袋,它在历史上一直被认为是“不可成药的”。然而,药物设计的改进最终导致了针对突变型 KRAS 处于活性或非活性状态的抑制剂的开发。其中一些抑制剂已被证明在 KRAS 突变型癌症患者中具有疗效,并改变了临床实践。这些进展带来的兴奋情绪因耐药性而受到抑制,耐药性限制了这些药物的反应深度和/或持续时间。对癌细胞中 RAS 信号转导和肿瘤微环境的理解的提高表明,几种新的联合治疗方法具有潜力,目前正在临床试验中进行探索。在此,我们概述了 RAS 通路,并回顾了针对致癌性 RAS 的治疗策略的开发和现状,以及它们改善 RAS 突变恶性肿瘤患者结局的潜力。然后,我们讨论了耐药机制带来的挑战以及克服这些挑战的策略。
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