Drug resistance of targeted therapy for advanced non-small cell lung cancer harbored EGFR mutation: from mechanism analysis to clinical strategy

• Published in: Journal of cancer research and clinical oncology Vol. 147; no. 12; pp. 3653 - 3664
• Main Authors: Zhao, Yuxin, Wang, Haiyong, He, Chengwei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer Nature B.V
• Subjects: Antineoplastic Agents - therapeutic use; c-Met protein; Cancer Research; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Chemotherapy; Cytotoxicity; Drug delivery; Drug resistance; Drug Resistance, Neoplasm - physiology; Epidermal growth factor; Epidermal growth factor receptors; ErbB protein; ErbB Receptors - antagonists & inhibitors; ErbB Receptors - genetics; ErbB-2 protein; Hematology; Hepatocyte growth factor; Humans; Insulin; Insulin-like growth factor I; Internal Medicine; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Medicine; Medicine & Public Health; Mesenchyme; Molecular Targeted Therapy - methods; Mutation; Non-small cell lung carcinoma; Oncology; Protein Kinase Inhibitors - therapeutic use; Protein-tyrosine kinase; PTEN protein; Review – Clinical Oncology; Small cell lung carcinoma; Stat3 protein; Tensin; Transcription activation; Tumors; Vascular endothelial growth factor; Drug resistance; Targeted therapy; Non-small cell lung cancer; Epidermal growth factor receptor-tyrosine kinase inhibitor
• ISSN: 0171-5216; 1432-1335; 1432-1335
• DOI: 10.1007/s00432-021-03828-8

Purpose Non-small cell lung cancer (NSCLC) accounts for about 85% in all cases of lung cancer. In recent years, molecular targeting drugs for NSCLC have been developed rapidly. The epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have changed the paradigm of cancer therapy from empirical cytotoxic chemotherapy to molecular-targeted cancer therapy. Currently, there are three generations of EGFR-TKIs, all of which have achieved good efficacy in clinical therapy. However, most patients developed drug resistance after 6–13 months EGFR-TKIs treatment. Therefore, a comprehensive understanding of EGFR-TKIs resistance mechanisms is of vital importance for clinical management of NSCLC. Methods Relevant data and information about the topic were obtained by searching PubMed (Medline), Web of Science and Google Scholar using the subject headings, such as “NSCLC”, “EGFR-TKIs resistance”, “EGFR mutations”, “human epidermal growth factor receptor-2 (HER2/erbB-2)”, “hepatocyte growth factor (HGF)”, “vascular endothelial growth factor (VEGF)”, “insulin-like growth factor 1 (IGF-1)”, “epithelial–mesenchymal transition (EMT)”, “phosphatase and tensin homolog (PTEN)”, “RAS mutation”, “BRAF mutation”, “signal transducer and activator of transcription 3 (STAT3)”, and “tumor microenvironment”, etc. Results The mechanisms for EGFR-TKIs resistance include EGFR mutations, upregulation of HER2, HGF/c-MET, VEGF IGF1, EMT and STAT3 pathways, mutations of PTEN, RAS and BRAF genes, and activation of other by-pass pathways. These mechanisms are interconnected and can be potential targets for the treatment of NSCLC. Conclusion In this review, we discuss the mechanisms of EGFR-TKIs drug resistance and the clinical strategies to overcome drug resistance from the perspective of EGFR-TKIs combined treatment.