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KRAS mutation: from undruggable to druggable in cancer
Lamei Huang1, Zhixing Guo1, Fang Wang1
1State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Esophageal Cancer Institute, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, P. R. China.
Abstract:
Cancer is the leading cause of death worldwide, and its treatment and outcomes have been dramatically revolutionised by targeted therapies. As the most frequently mutated oncogene, Kirsten rat sarcoma viral oncogene homologue (KRAS) has attracted substantial attention. The understanding of KRAS is constantly being updated by numerous studies on KRAS in the initiation and progression of cancer diseases. However, KRAS has been deemed a challenging therapeutic target, even "undruggable", after drug-targeting efforts over the past four decades. Recently, there have been surprising advances in directly targeted drugs for KRAS, especially in KRAS (G12C) inhibitors, such as AMG510 (sotorasib) and MRTX849 (adagrasib), which have obtained encouraging results in clinical trials. Excitingly, AMG510 was the first drug-targeting KRAS (G12C) to be approved for clinical use this year. This review summarises the most recent understanding of fundamental aspects of KRAS, the relationship between the KRAS mutations and tumour immune evasion, and new progress in targeting KRAS, particularly KRAS (G12C). Moreover, the possible mechanisms of resistance to KRAS (G12C) inhibitors and possible combination therapies are summarised, with a view to providing the best regimen for individualised treatment with KRAS (G12C) inhibitors and achieving truly precise treatment.
Insights
Targeting Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations, especially KRAS (G12C), has shown promise in cancer treatment. Recent advances include approved KRAS (G12C) inhibitors, offering new hope for precise cancer therapies.
Area of Science:
- Oncology
- Molecular Biology
- Drug Discovery
Background:
- Cancer remains a leading cause of death globally, with targeted therapies revolutionizing treatment outcomes.
- Kirsten rat sarcoma viral oncogene homologue (KRAS) is the most frequently mutated oncogene, playing a critical role in cancer initiation and progression.
- Despite extensive efforts, KRAS has historically been a challenging, often considered
- undruggable
- therapeutic target.
Purpose of the Study:
- To review the fundamental aspects of KRAS and its mutations in cancer.
- To explore the link between KRAS mutations and tumor immune evasion.
- To summarize recent advancements in targeting KRAS, particularly the KRAS (G12C) mutation, including novel inhibitors and combination therapies.
Main Methods:
- Literature review of recent studies on KRAS.
- Analysis of clinical trial data for KRAS (G12C) inhibitors.
- Discussion of resistance mechanisms and combination treatment strategies.
Main Results:
- Significant progress has been made in developing direct KRAS (G12C) inhibitors like sotorasib (AMG510) and adagrasib (MRTX849).
- Sotorasib (AMG510) is the first KRAS (G12C)-targeted drug approved for clinical use, demonstrating encouraging clinical trial results.
- KRAS mutations are implicated in tumor immune evasion, highlighting potential for immunotherapy combinations.
Conclusions:
- Targeting KRAS (G12C) represents a breakthrough in precision oncology.
- Understanding resistance mechanisms is crucial for optimizing treatment with KRAS (G12C) inhibitors.
- Combination therapies hold promise for improving patient outcomes and achieving personalized cancer treatment.
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