Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib

Neurotrophic receptor kinase (NTRK) fusions are actionable oncogenic drivers of multiple pediatric and adult solid tumors, and tropomyosin receptor kinase (TRK) has been considered as an attractive therapeutic target for “pan-cancer” harboring these fusions. Currently, two generations TRK inhibitors...

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Main Authors: Shuang Xiang, Xiaoyun Lu
Format: Article
Language:English
Published: Elsevier 2024-02-01
Series:Acta Pharmaceutica Sinica B
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2211383523004331
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author Shuang Xiang
Xiaoyun Lu
author_facet Shuang Xiang
Xiaoyun Lu
author_sort Shuang Xiang
collection DOAJ
description Neurotrophic receptor kinase (NTRK) fusions are actionable oncogenic drivers of multiple pediatric and adult solid tumors, and tropomyosin receptor kinase (TRK) has been considered as an attractive therapeutic target for “pan-cancer” harboring these fusions. Currently, two generations TRK inhibitors have been developed. The representative second-generation inhibitors selitrectinib and repotrectinib were designed to overcome clinic acquired resistance of the first-generation inhibitors larotrectinib or entrectinib resulted from solvent-front and gatekeeper on-target mutations. However, xDFG (TRKAG667C/A/S, homologous TRKCG696C/A/S) and some double mutations still confer resistance to selitrectinib and repotrectinib, and overcoming these resistances represents a major unmet clinical need. In this review, we summarize the acquired resistance mechanism of the first- and second-generation TRK inhibitors, and firstly put forward the emerging selective type II TRK inhibitors to overcome xDFG mutations mediated resistance. Additionally, we concluded our perspectives on new challenges and future directions in this field.
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spelling doaj.art-fb1aa15530ab401bbd921ce0f856db272024-01-29T04:15:24ZengElsevierActa Pharmaceutica Sinica B2211-38352024-02-01142517532Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinibShuang Xiang0Xiaoyun Lu1International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou City Key Laboratory of Precision Chemical Drug Development, School of Pharmacy, Jinan University, Guangzhou 510632, ChinaCorresponding author.; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Guangzhou City Key Laboratory of Precision Chemical Drug Development, School of Pharmacy, Jinan University, Guangzhou 510632, ChinaNeurotrophic receptor kinase (NTRK) fusions are actionable oncogenic drivers of multiple pediatric and adult solid tumors, and tropomyosin receptor kinase (TRK) has been considered as an attractive therapeutic target for “pan-cancer” harboring these fusions. Currently, two generations TRK inhibitors have been developed. The representative second-generation inhibitors selitrectinib and repotrectinib were designed to overcome clinic acquired resistance of the first-generation inhibitors larotrectinib or entrectinib resulted from solvent-front and gatekeeper on-target mutations. However, xDFG (TRKAG667C/A/S, homologous TRKCG696C/A/S) and some double mutations still confer resistance to selitrectinib and repotrectinib, and overcoming these resistances represents a major unmet clinical need. In this review, we summarize the acquired resistance mechanism of the first- and second-generation TRK inhibitors, and firstly put forward the emerging selective type II TRK inhibitors to overcome xDFG mutations mediated resistance. Additionally, we concluded our perspectives on new challenges and future directions in this field.http://www.sciencedirect.com/science/article/pii/S2211383523004331NTRK fusionsTRK kinaseClinical resistancexDFG mutationsSelective type II inhibitors
spellingShingle Shuang Xiang
Xiaoyun Lu
Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
Acta Pharmaceutica Sinica B
NTRK fusions
TRK kinase
Clinical resistance
xDFG mutations
Selective type II inhibitors
title Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
title_full Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
title_fullStr Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
title_full_unstemmed Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
title_short Selective type II TRK inhibitors overcome xDFG mutation mediated acquired resistance to the second-generation inhibitors selitrectinib and repotrectinib
title_sort selective type ii trk inhibitors overcome xdfg mutation mediated acquired resistance to the second generation inhibitors selitrectinib and repotrectinib
topic NTRK fusions
TRK kinase
Clinical resistance
xDFG mutations
Selective type II inhibitors
url http://www.sciencedirect.com/science/article/pii/S2211383523004331
work_keys_str_mv AT shuangxiang selectivetypeiitrkinhibitorsovercomexdfgmutationmediatedacquiredresistancetothesecondgenerationinhibitorsselitrectinibandrepotrectinib
AT xiaoyunlu selectivetypeiitrkinhibitorsovercomexdfgmutationmediatedacquiredresistancetothesecondgenerationinhibitorsselitrectinibandrepotrectinib