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Mechanisms of Acquired Resistance to ALK Inhibitors and the Rationale for Treating ALK-positive Lung Cancer

Department of Clinical Pharmaceutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
Department of General Internal Medicine 4, Kawasaki Medical School, Okayama 700-8505, Japan
Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama 700-8558, Japan
Author to whom correspondence should be addressed.
Academic Editor: Siow Ming Lee
Cancers 2015, 7(2), 763-783;
Received: 28 February 2015 / Revised: 14 April 2015 / Accepted: 21 April 2015 / Published: 30 April 2015
(This article belongs to the Special Issue Non-Small Cell Lung Cancer Therapies)
PDF [711 KB, uploaded 30 April 2015]


The discovery of an echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene led to improved clinical outcomes in patients with lung cancer after the development of the first ALK-targeting agent, crizotinib. Some second-generation ALK tyrosine kinase inhibitors (TKIs), which might be more potent than crizotinib or effective on crizotinib-resistant patients, have been developed. Although these ALK-TKIs show an excellent response initially, most patients eventually acquire resistance. Therefore, careful consideration of the resistance mechanisms might lead to superior therapeutic strategies. Here, we summarize the history of ALK-TKIs and their underlying resistance mechanisms in both the preclinical and clinical settings. In addition, we discuss potential future treatment strategies in ALK-TKI-naïve and -resistant patients with lung cancer harboring the EML4-ALK fusion gene. View Full-Text
Keywords: lung cancer; EML4-ALK; crizotinib; ceritinib; alectinib; resistance lung cancer; EML4-ALK; crizotinib; ceritinib; alectinib; resistance

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Isozaki, H.; Takigawa, N.; Kiura, K. Mechanisms of Acquired Resistance to ALK Inhibitors and the Rationale for Treating ALK-positive Lung Cancer. Cancers 2015, 7, 763-783.

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