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Man X, Sun X, Chen C, Xiang Y, Zhang J, Yang L. The current landscape, advancements, and prospects in the treatment of patients with EGFR exon 20 insertion mutations warrant scientific elucidation. Front Oncol 2024; 14:1367204. [PMID: 38919530 PMCID: PMC11196869 DOI: 10.3389/fonc.2024.1367204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations are the third most prevalent mutation in non-small cell lung cancer (NSCLC), following the 19del and L858R mutations. The unique nature of the EGFR ex20ins mutation poses challenges for the effectiveness of first- and second-generation EGFR tyrosine kinase inhibitors (TKIs). As a result, chemotherapy remains the primary and more effective treatment approach. However, with advancements in time and technology, numerous experimental studies have revealed the potential of novel drugs and therapies to have stronger inhibitory effects on EGFR ex20ins mutations. In this comprehensive review, we provide an overview of the current treatment landscape, recent advancements, and the prospects for patients with advanced NSCLC characterized by EGFR ex20ins mutations.
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Affiliation(s)
| | | | | | | | | | - Lei Yang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Duan L, Chu C, Huang X, Yao H, Wen J, Chen R, Wang C, Tu Y, Lv Q, Pan Q, Xu S. Rational design and synthesis of 2,4-dichloro-6-methyl pyrimidine derivatives as potential selective EGFR T790M/L858R inhibitors for the treatment of non-small cell lung cancer. Arch Pharm (Weinheim) 2024; 357:e2300736. [PMID: 38381049 DOI: 10.1002/ardp.202300736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
Many patients with non-small cell lung cancer (NSCLC) initially benefit from epidermal growth factor receptor (EGFR) targeted therapy. Unfortunately, varying degrees of resistance or side effects eventually develop. Overcoming and preventing the resistance and side effects of EGFR inhibitors has become a hot topic of research today. Based on the previous studies on AZD-9291, we designed and synthesized two series of 2,4-dichloro-6-methylpyrimidine derivatives, 19 compounds in total, as potential inhibitors of the EGFR kinase. The most promising compound, L-18, showed better inhibitory activity (81.9%) and selectivity against EGFRT790M/L858R kinase. In addition, L-18 showed strong antiproliferative activity against H1975 cells with an IC50 value of 0.65 ± 0.06 μM and no toxicity to normal cells (LO-2). L-18 was able to dose-dependently induce the apoptosis of H1975 cells and produced a cell-cycle-blocking effect, and it can also dose-dependently inhibit the migration and invasion of H1975 cells. L-18 also showed in vivo anticancer efficacy in H1975 cells xenograft mice. We also performed a series of in vivo and in vitro toxicological evaluations of compound L-18, which did not cause obvious injury in mice during administration. These results suggest that L-18 may be a promising drug candidate that warrants further investigation.
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Affiliation(s)
- Lei Duan
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Cilong Chu
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Xiaoling Huang
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Huizhi Yao
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Jie Wen
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Rui Chen
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Caolin Wang
- School of Pharmacy, East China University of Science & Technology, Shanghai, China
| | - Yuanbiao Tu
- Cancer Research Center, Jangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qiaoli Lv
- Jiangxi Key Laboratory of Translational Cancer Research, Jiangxi Cancer Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Qingshan Pan
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
| | - Shan Xu
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, Jiangxi Science & Technology Normal University, Nanchang, Jiangxi, China
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Liu J, Xiang Y, Fang T, Zeng L, Sun A, Lin Y, Lu K. Advances in the Diagnosis and Treatment of Advanced Non-Small-Cell Lung Cancer With EGFR Exon 20 Insertion Mutation. Clin Lung Cancer 2024; 25:100-108. [PMID: 38172024 DOI: 10.1016/j.cllc.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
The discovery of epidermal growth factor receptor (EGFR) mutations has greatly changed the clinical outlook for patients with advanced non-small-cell lung cancer (NSCLC). Unlike the most common EGFR mutations, such as exon 19 deletion (del19) and exon 21 L858R point mutation, EGFR exon 20 insertion mutation (EGFR ex20ins) is a rare mutation of EGFR. Due to its structural specificity, it exhibits primary resistance to traditional epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), leading to poor overall survival prognosis for patients. In recent years, there has been continuous progress in the development of new drugs targeting EGFR ex20ins, bringing new hope for the treatment of this patient population. In this regard, we conducted a systematic review of the molecular characteristics, diagnostic advances, and treatment status of EGFR ex20ins. We summarized the latest data on relevant drug development and clinical research, aiming to provide reference for clinical diagnosis, treatment, and drug development.
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Affiliation(s)
- Jingwen Liu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Xiang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tingwen Fang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lulin Zeng
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ao Sun
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yixiang Lin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kaihua Lu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Duan J, Wu L, Yang K, Zhao J, Zhao Y, Dai X, Li M, Xie Y, Yao Y, Zhao M, Zhou C, Ren X, Liu Z, Pan Y, Li Y, Liu B, Cheng Y, Miao L, Yu Q, Zhang Z, Liu X, Cui J, Zhang Y, Zhang L, Li X, Li X, Shen B, Chen B, Zeng S, Li B, Hu Y, Li L, Wu R, Song Q, Wang J. Safety, Tolerability, Pharmacokinetics, and Preliminary Efficacy of YK-029A in Treatment-Naive Patients With Advanced NSCLC Harboring EGFR Exon 20 Insertion Mutations: A Phase 1 Trial. J Thorac Oncol 2024; 19:314-324. [PMID: 37776953 DOI: 10.1016/j.jtho.2023.09.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Treatment options for treatment-naive patients with advanced NSCLC harboring EGFR exon 20 insertion (ex20ins) mutations are limited. This study evaluated the safety, tolerability, and pharmacokinetics of YK-029A, a third-generation EGFR tyrosine kinase inhibitor, and the preliminary efficacy of YK-029A in treatment-naive patients with EGFR ex20ins mutation. METHODS This multicenter, dose-escalation, and dose-expansion phase 1 clinical trial enrolled patients with NSCLC harboring EGFR mutations. During the dose-escalation phase, YK-029A was orally administered using the traditional 3+3 principle at 50, 100, 150, 200, and 250 mg/d. In the dose-expansion phase, treatment-naive patients with EGFR ex20ins mutations were enrolled and administered YK-029A 200 mg/d. The primary end point was safety and tolerability. RESULTS The safety analysis included 108 patients. No dose-limiting toxicity was observed, and the maximum tolerated dose was not reached. The most common treatment-emergent adverse events were anemia (50.9%), diarrhea (49.1%), and rash (34.3%). There was minimal drug accumulation after multiple doses. A total of 28 treatment-naive patients with EGFR ex20ins mutations were enrolled in the dose-expansion and 26 were included in the efficacy analysis. According to the independent review committee evaluation, the objective response rate was 73.1% (95% confidence interval: 52.21%-88.43%), and the disease control rate was 92.3% (95% confidence interval: 74.87%-99.05%). CONCLUSIONS YK-029A was found to have manageable safety and be tolerable in patients with NSCLC harboring EGFR mutations and have promising antitumor activity in untreated patients with EGFR ex20ins mutations.
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Affiliation(s)
- Jianchun Duan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Shanxi Cancer Hospital (Shanxi Cancer Institute), Cancer Hospital of Chinese Academy of Medical Sciences Shanxi Hospital, Shanxi Medical University Affiliated Hospital, Taiyuan, People's Republic of China
| | - Lin Wu
- Thoracic Department II, Hunan Cancer Hospital, Changsha, People's Republic of China
| | - Kunyu Yang
- Department of Head and Neck Oncology, Cancer Center, Wuhan Union Hospital, Wuhan, People's Republic of China
| | - Jun Zhao
- Department of Thoracic Oncology, Peking University Cancer Hospital, Beijing, People's Republic of China
| | - Yanqiu Zhao
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan, People's Republic of China
| | - Xiumei Dai
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Mingjun Li
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yanyan Xie
- Clinical Cancer Center Oncology Department 1, Guangxi Zhuang Autonomous Region People's Hospital, Nanning, People's Republic of China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Mingfang Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Chengzhi Zhou
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiubao Ren
- Department of Biotherapy Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Zhe Liu
- Department of Oncology, Beijing Chest Hospital, Beijing, People's Republic of China
| | - Yueyin Pan
- Department of Tumor Chemotherapy, Anhui Provincial Hospital, Hefei, People's Republic of China
| | - Yuping Li
- Department of Respiratory and Critical Care, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Baogang Liu
- Respiratory Ward 1, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Cancer Hospital, Changchun, People's Republic of China
| | - Liyun Miao
- The Affiliated Hospital of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Qitao Yu
- Department of Respiratory Oncology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Zhihong Zhang
- Department of Respiratory, Anhui Cancer Hospital, Hefei, People's Republic of China
| | - Xiaoqing Liu
- Department of Oncology, Fifth Medical Center, Liberation General Hospital, Beijing, People's Republic of China
| | - Jiuwei Cui
- Department of Respiratory, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yu Zhang
- Department of Respiratory, Nanjing Chest Hospital, Nanjing, People's Republic of China
| | - Li Zhang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Xiaoyan Li
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoling Li
- Thoracic Medicine, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China
| | - Bo Shen
- Medical Department, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Bi Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Shan Zeng
- Department of Oncology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Bin Li
- Department of Oncology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yanping Hu
- Department of Medical Oncology, Cancer Hospital of Hubei Province, Wuhan, People's Republic of China
| | - Lin Li
- Department of Oncology, Beijing Hospital, Beijing, People's Republic of China
| | - Rong Wu
- Department of Medical Oncology, Shengjing Hospital Of China Medical University, Shenyang, People's Republic of China
| | - Qibin Song
- Department of Oncology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, People's Republic of China
| | - Jie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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