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

  • Review – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

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.

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Funding

This work was supported by the Macao Science and Technology Development Fund (070/2017/A2, 0024/2020/A1), the Research Fund of the University of Macau (MYRG2018-00176-ICMS), Macao Young Scholars Program (AM201911) and the 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund (Guangdong-Hong Kong-Macau Joint Lab) (2020B1212030006).

Author information

Author notes

  1. Yuxin Zhao and Haiyong Wang equally contributing to the manuscript.

Authors and Affiliations

  1. State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, 999078, Macao SAR, China

    Yuxin Zhao, Haiyong Wang & Chengwei He

  2. Department of Pharmaceutical Science, University of Macau, Taipa, 999078, Macao SAR, China

    Yuxin Zhao, Haiyong Wang & Chengwei He

  3. Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, University of Macau, Taipa, 999078, Macao SAR, China

    Yuxin Zhao, Haiyong Wang & Chengwei He

  4. School of Medicine, Shandong University, Jinan, 250012, China

    Haiyong Wang

Authors
  1. Yuxin Zhao
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  2. Haiyong Wang
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  3. Chengwei He
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The authors contributed equally to this work.

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Correspondence to Chengwei He.

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Zhao, Y., Wang, H. & He, C. Drug resistance of targeted therapy for advanced non-small cell lung cancer harbored EGFR mutation: from mechanism analysis to clinical strategy. J Cancer Res Clin Oncol 147, 3653–3664 (2021). https://doi.org/10.1007/s00432-021-03828-8

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