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Review
. 2022 Jan 1;30(1):19-27.
doi: 10.4062/biomolther.2021.047.

Chronicles of EGFR Tyrosine Kinase Inhibitors: Targeting EGFR C797S Containing Triple Mutations

Krishna Babu Duggirala  1   2 , Yujin Lee  1   2 , Kwangho Lee  1   2
Affiliations
Review

Chronicles of EGFR Tyrosine Kinase Inhibitors: Targeting EGFR C797S Containing Triple Mutations

Krishna Babu Duggirala et al. Biomol Ther (Seoul). .

Abstract

Epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase widely expressed in many cancers such as non-small cell lung cancer (NSCLC), pancreatic cancer, breast cancer, and head and neck cancer. Mutations such as L858R in exon 21, exon 19 truncation (Del19), exon 20 insertions, and others are responsible for aberrant activation of EGFR in NSCLC. First-generation EGFR tyrosine kinase inhibitors (TKIs) such as gefitinib and erlotinib have clinical benefits for EGFR-sensitive (L858R and Del19) NSCLC patients. However, after 10-12 months of treatment with these inhibitors, a secondary T790M mutation at the gatekeeper position in the kinase domain of EGFR was identified, which limited the clinical benefits. Second-generation EGFR irreversible inhibitors (afatinib and dacomitinib) were developed to overcome this T790M mutation. However, their lack of selectivity toward wild-type EGFR compromised their clinical benefits due to serious adverse events. Recently developed third-generation irreversible EGFR TKIs (osimertinib and lazertinib) are selective toward driving mutations and the T790M mutation, while sparing wildtype EGFR activity. The latest studies have concluded that their efficacy was also compromised by additional acquired mutations, including C797S, the key residue cysteine that forms covalent bonds with irreversible inhibitors. Because second- and thirdgeneration EGFR TKIs are irreversible inhibitors, they are not effective against C797S containing EGFR triple mutations (Del19/T790M/C797S and L858R/T790M/C797S). Therefore, there is an urgent unmet medical need to develop next-generation EGFR TKIs that selectively inhibit EGFR triple mutations via a non-irreversible mechanism.

Keywords: Acquired resistance; C797S; EGFR; NSCLC; T790M; TKIs.

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Figures

Fig. 1
Fig. 1
EGFR cellular signaling pathway (Finigan et al., 2012) (Permission granted by the American Thoracic Society).
Fig. 2
Fig. 2
Frequency of EGFR mutations in lung cancer and availability of targeted tyrosine kinase inhibitors (modified from the original figure, Kobayashi and Mitsudomi, 2016) [Permission granted from the publisher (John Wiley and Sons)].
Fig. 3
Fig. 3
First-generation EGFR inhibitors.
Fig. 4
Fig. 4
Second-generation EGFR inhibitors.
Fig. 5
Fig. 5
Third-generation EGFR inhibitors.
Fig. 6
Fig. 6
Allosteric EGFR inhibitors.
Fig. 7
Fig. 7
Structure of DDC-01-163 an allosteric EGFR degrader.
See this image and copyright information in PMC

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