An updated overview of K-RAS G12C inhibitors in advanced stage non-small cell lung cancer

Future Oncol. 2024;20(37):3019-3038. doi: 10.1080/14796694.2024.2407280. Epub 2024 Oct 3.

Abstract

The discovery of KRAS mutations, particularly the KRASG12C variant, has been a milestone in understanding the molecular underpinnings of non-small cell lung cancer (NSCLC). These mutations are associated with aggressive tumor behavior and resistance to conventional therapies, highlighting the urgent need for targeted interventions. In this comprehensive review, we analyze the advancements in KRAS G12C inhibitors for the treatment of non-small cell lung cancer. Literature search is made from PubMed, Medline ASCO and ESMO Annual Meetings abstracts by using the following search keywords: "sotorasib", "adagrasib", "divarasib" and "KRAS G12C inhibitors." The last search was on 5 June 2024. This review highlights the importance of pharmacokinetics, pharmacodynamics and potential adverse effects for treating individual patients and ensuring the best outcomes. Additionally, the review discusses research identifying biomarkers that can predict therapy responses and mentions the combination strategies to overcome resistance. Results of the studies and ongoing clinical trials are also briefly summarized in this review. KRASG12C inhibitors sotorasib, adagrasib and the newer divarasib, has revolutionized treating patients harboring this mutation. Ongoing studies and future clinical trials will refine our understandings with the ultimate goal of improving survival and quality of life for patients with this challenging disease.

Keywords: KRAS G12C inhibitors; adagrasib; non-small cell lung cancer (NSCLC); precision oncology; resistance mechanisms; sotorasib; targeted treatments.

Plain language summary

[Box: see text].

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / pharmacology
  • Antineoplastic Agents / therapeutic use
  • Biomarkers, Tumor
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • Carcinoma, Non-Small-Cell Lung* / pathology
  • Drug Resistance, Neoplasm
  • Humans
  • Lung Neoplasms* / drug therapy
  • Lung Neoplasms* / genetics
  • Lung Neoplasms* / pathology
  • Molecular Targeted Therapy / methods
  • Mutation*
  • Neoplasm Staging
  • Piperazines
  • Proto-Oncogene Proteins p21(ras)* / antagonists & inhibitors
  • Proto-Oncogene Proteins p21(ras)* / genetics
  • Pyridines
  • Pyrimidines

Substances

  • Proto-Oncogene Proteins p21(ras)
  • KRAS protein, human
  • Antineoplastic Agents
  • sotorasib
  • Biomarkers, Tumor
  • Piperazines
  • Pyridines
  • Pyrimidines