Therapeutic strategies utilized in the setting of acquired resistance to EGFR tyrosine kinase inhibitors

Abstract

Patients with EGFR-mutant lung cancer derive significant therapeutic benefit from treatment with EGFR tyrosine kinase inhibitors (TKI). Unfortunately, acquired resistance is an inevitable consequence of this treatment strategy, with a broad variety of resistance mechanisms including acquired EGFR mutations (e.g., T790M) and activation of bypass signaling pathways, such as MET and HER2. Several therapeutic strategies hypothesized to delay or overcome resistance have been tested in clinical trials, including "next-generation" EGFR TKIs and rational combinations of targeted agents. However, to date, there are no FDA-approved therapies for patients with acquired resistance to first-line EGFR TKI therapy. There remains a critical need for more effective and better tailored treatments in this setting to match treatments to the individual patient and specific resistance mechanism at hand. In this review, we discuss known mechanisms of resistance to first-line EGFR TKI therapy and describe previous and ongoing strategies to overcome resistance.

Figure 1

EGFR signaling pathways and receptor cross-talk. Activation of EGFR propagates downstream pro-growth signals through the MAPK pathway (RAS-RAF-MEK-ERK) and PI3K-AKT-mTOR pathway. Targets for potential combinatorial therapeutic strategies to overcome resistance are noted.