克服表皮生长因子受体(EGFR)突变型肺癌对奥希替尼耐药的策略
Strategies to Overcome Resistance to Osimertinib in EGFR-Mutated Lung Cancer.
作者信息
Romaniello Donatella, Morselli Alessandra, Marrocco Ilaria
机构信息
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
出版信息
Int J Mol Sci. 2025 Mar 25;26(7):2957. doi: 10.3390/ijms26072957.
Non-small-cell lung cancer (NSCLC) represents the most common type of lung cancer. The majority of patients with lung cancer characterized by activating mutations in the epidermal growth factor receptor (EGFR), benefit from therapies entailing tyrosine kinase inhibitors (TKIs). In this regard, osimertinib, a third-generation EGFR TKI, has greatly improved the outcome for patients with EGFR-mutated lung cancer. The AURA and FLAURA trials displayed the superiority of the third-generation TKI in both first- and second-line settings, making it the drug of choice for treating patients with EGFR-mutated lung cancer. Unfortunately, the onset of resistance is almost inevitable. On-target mechanisms of resistance include new mutations (e.g., C797S) in the kinase domain of EGFR, while among the off-target mechanisms, amplification of MET or HER2, mutations in downstream signaling molecules, oncogenic fusions, and phenotypic changes (e.g., EMT) have been described. This review focuses on the strategies that are currently being investigated, in preclinical and clinical settings, to overcome resistance to osimertinib, including the use of fourth-generation TKIs, PROTACs, bispecific antibodies, and ADCs, as monotherapy and as part of combination therapies.
非小细胞肺癌(NSCLC)是最常见的肺癌类型。大多数以表皮生长因子受体(EGFR)激活突变为特征的肺癌患者受益于酪氨酸激酶抑制剂(TKI)治疗。在这方面,第三代EGFR TKI奥希替尼极大地改善了EGFR突变型肺癌患者的治疗效果。AURA和FLAURA试验显示了第三代TKI在一线和二线治疗中的优越性,使其成为治疗EGFR突变型肺癌患者的首选药物。不幸的是,耐药性的出现几乎不可避免。耐药的靶向机制包括EGFR激酶结构域中的新突变(如C797S),而在非靶向机制中,已描述了MET或HER2扩增、下游信号分子突变、致癌融合和表型变化(如EMT)。本综述重点关注目前在临床前和临床环境中正在研究的克服对奥希替尼耐药的策略,包括使用第四代TKI、PROTAC、双特异性抗体和ADC,作为单一疗法以及联合疗法的一部分。