Tyrosine kinase inhibitor

Short description: Drug typically used in cancer treatment

Crystal structure of the second generation Bcr-Abl tyrosine-kinase inhibitor nilotinib (red) in complex with an Abl kinase domain (blue). Nilotinib is used to treat chronic myelogenous leukemia (CML), a hematological malignancy.

A tyrosine kinase inhibitor (TKI) is a pharmaceutical drug that inhibits tyrosine kinases. Tyrosine kinases are enzymes responsible for the activation of many proteins by signal transduction cascades. The proteins are activated by adding a phosphate group to the protein (phosphorylation), a step that TKIs inhibit. TKIs are typically used as anticancer drugs. For example, they have substantially improved outcomes in chronic myelogenous leukemia. They have also been used to treat other diseases, such as idiopathic pulmonary fibrosis.

They are also called tyrphostins, the short name for "tyrosine phosphorylation inhibitor", originally coined in a 1988 publication,[1] which was the first description of compounds inhibiting the catalytic activity of the epidermal growth factor receptor (EGFR).

The 1988 study was the first demonstration of a systematic search and discovery of small-molecular-weight inhibitors of tyrosine phosphorylation, which do not inhibit protein kinases that phosphorylate serine or threonine residues and can discriminate between the kinase domains of the EGFR and that of the insulin receptor. It was further shown that in spite of the conservation of the tyrosine-kinase domains one can design and synthesize tyrphostins that discriminate between even closely related protein tyrosine kinases such as EGFR and its close relative HER2.[2][3]

## Contents

* 1 Development of drugs
* 2 Mechanisms
* 3 See also
* 4 References

## Development of drugs

Numerous TKIs aiming at various tyrosine kinases have been generated by the originators of these compounds and proven to be effective anti-tumor agents and anti-leukemic agents.[4][5] Based on this work imatinib was developed against chronic myelogenous leukemia (CML)[6] and later gefitinib and erlotinib aiming at the EGF receptor. Dasatinib is a Src tyrosine kinase inhibitor that is effective both as a senolytic and as therapy for CML.[7]

Sunitinib, an inhibitor of the receptors for FGF, PDGF and VEGF is also based on early studies on TKIs aiming at VEGF receptors.[8]

Adavosertib is a Wee1 kinase inhibitor that is undergoing numerous clinical trials in the treatment of refractory solid tumors.[9] However, toxicities such as myelosuppression, diarrhea, and supraventricular tachyarrhythmia have arisen while attempting to determine the toxicity and effectiveness of the drug.[10]

Lapatinib, FDA-approved for treatment in conjunction with chemotherapy or hormone therapy, is also currently undergoing clinical trials in the treatment of HER2-overexpressing breast cancers as it is suggested intermittent high-dose therapy might have better efficacy with manageable toxicity than the standard continuous dosing. A Phase I clinical trial found responses and dramatic responses to this line of treatment, with the most common toxicity being diarrhea.[11]

Imatinib, sunitinib, sorafenib, and pazopanib have been studied in the treatment of aggressive fibromatosis (desmoid tumor).[12][13]

## Mechanisms

TKIs operate by four different mechanisms: they can compete with adenosine triphosphate (ATP), the phosphorylating entity, the substrate or both or can act in an allosteric fashion, namely bind to a site outside the active site, affecting its activity by a conformational change.[14] Recently TKIs have been shown to deprive tyrosine kinases of access to the Cdc37-Hsp90 molecular chaperone system on which they depend for their cellular stability, leading to their ubiquitylation and degradation.[15] Signal transduction therapy can also be used for non-cancer proliferative diseases and for inflammatory conditions.[16] An example is nintedanib for the treatment of idiopathic pulmonary fibrosis.[17]

## See also

* Bcr-Abl tyrosine-kinase inhibitor
* Protein kinase inhibitor

## References

1. ↑ "Blocking of EGF-dependent cell proliferation by EGF receptor kinase inhibitors". Science 242 (4880): 933–935. 1988. doi:10.1126/science.3263702. PMID 3263702. Bibcode: 1988Sci...242..933Y.
2. ↑ "Tyrphostins. 2. Heterocyclic and alpha-substituted benzylidenemalononitrile tyrphostins as potent inhibitors of EGF receptor and ErbB2/neu tyrosine kinases". J Med Chem 34 (6): 1896–907. 1991. doi:10.1021/jm00110a022. PMID 1676428.
3. ↑ "Selective inhibition of the epidermal growth factor and HER2/neu receptors by tyrphostins". J Biol Chem 268 (15): 11134–42. 1993. doi:10.1016/S0021-9258(18)82102-0. PMID 8098709.
4. ↑ "Tyrphostin-induced inhibition of p210bcr-abl tyrosine kinase activity induces K562 to differentiate". Blood 82 (12): 3524–9. 1993. doi:10.1182/blood.V82.12.3524.3524. PMID 7505115.
5. ↑ "Inhibition of acute lymphoblastic leukaemia by a Jak-2 inhibitor". Nature 379 (6566): 645–8. 1996. doi:10.1038/379645a0. PMID 8628398. Bibcode: 1996Natur.379..645M.
6. ↑ "Effects of a selective inhibitor of the Abl tyrosine kinase on the growth of Bcr-Abl positive cells". Nat Med 2 (5): 561–6. 1996. doi:10.1038/nm0596-561. PMID 8616716.
7. ↑ "Src Tyrosine Kinase Inhibitors: New Perspectives on Their Immune, Antiviral, and Senotherapeutic Potential". Frontiers in Pharmacology 10. 2019. doi:10.3389/fphar.2019.01011. PMID 31619990.
8. ↑ "Flk-1 as a target for tumor growth inhibition". Cancer Res. 56 (15): 3540–5. 1996. PMID 8758924.
9. ↑ "NCI drug dictionary adavosertib". 2 February 2011. https://www.cancer.gov/publications/dictionaries/cancer-drug/def/wee1-inhibitor-azd1775.
10. ↑ "Phase I study of single-agent AZD1775 (MK-1775), a Wee1 kinase inhibitor, in patients with refractory solid tumors". Journal of Clinical Oncology 33 (30): 3409–15. October 2015. doi:10.1200/JCO.2014.60.4009. PMID 25964244.
11. ↑ "Phase I dose-escalation study of 5-day intermittent oral lapatinib therapy in patients with human epidermal growth factor receptor 2–overexpressing breast cancer". Journal of Clinical Oncology 32 (14): 1472–79. May 2014. doi:10.1200/JCO.2013.52.1161. PMID 24711549.
12. ↑ Mangla, Ankit; Agarwal, Nikki; Schwartz, Gary (2024-01-25). "Desmoid Tumors: Current Perspective and Treatment". Current Treatment Options in Oncology 25 (2): 161–175. doi:10.1007/s11864-024-01177-5. ISSN 1527-2729. PMID 38270798.
13. ↑ Lee, Yong-Suk; Joo, Min Wook; Shin, Seung-Han; Hong, Sungan; Chung, Yang-Guk (2024-01-08). "Current Treatment Concepts for Extra-Abdominal Desmoid-Type Fibromatosis: A Narrative Review". Cancers 16 (2): 273. doi:10.3390/cancers16020273. ISSN 2072-6694. PMID 38254764.
14. ↑ "Kinetics of inhibition by tyrphostins of the tyrosine kinase activity of the epidermal growth factor receptor and analysis by a new computer program". Mol. Pharmacol. 45 (4): 673–83. 1994. doi:10.1016/S0026-895X(25)10152-1. PMID 8183246.
15. ↑ Polier (2013). "ATP-competitive inhibitors block protein kinase recruitment to the Hsp90-Cdc37 system". Nature Chemical Biology 9 (5): 307–312. doi:10.1038/nchembio.1212. PMID 23502424.
16. ↑ "Tyrphostins and other tyrosine kinase inhibitors". Annu Rev Biochem 75: 93–109. 2006. doi:10.1146/annurev.biochem.75.103004.142657. PMID 16756486.
17. ↑ "Vargatef EPAR". 20 January 2020. https://www.ema.europa.eu/en/medicines/human/EPAR/vargatef.

* v
* t
* e

Targeted cancer therapy / antineoplastic agents (L01)

CI monoclonal antibodies ("-mab")|

| Receptor tyrosine kinase|

* ErbB: HER1/EGFR (Cetuximab
* Panitumumab)
* HER2/neu (Trastuzumab
* Trastuzumab emtansine)

|

Others for solid tumors|

* EpCAM (Catumaxomab
* Edrecolomab)
* VEGF-A (Bevacizumab)

Leukemia/lymphoma|

* lymphoid: CD20 (Ibritumomab
* Obinutuzumab
* Ofatumumab
* Rituximab
* Tositumomab), CD30 (Brentuximab), CD52 (Alemtuzumab)

* myeloid: CD33 (Gemtuzumab)

Tyrosine kinase inhibitors ("-nib")|

| Receptor tyrosine kinase|

* ErbB: HER1/EGFR (Brigatinib
* Dacomitinib
* Erlotinib
* Gefitinib
* Olmutinib
* Osimertinib
* Rociletinib
* Vandetanib)
* HER1/EGFR and HER2/neu
* Afatinib
* Lapatinib
* Neratinib

* RTK class III: C-kit and PDGFR (Axitinib
* Masitinib
* Pazopanib
* Sorafenib
* Sunitinib
* Toceranib)
* FLT3 (Lestaurtinib)

* VEGFR
* Axitinib
* Cediranib
* Lenvatinib
* Nintedanib
* Pazopanib
* Regorafenib
* Semaxanib
* Sorafenib
* Sunitinib
* Tivozanib
* Toceranib
* Vandetanib

* ALK
* Alectinib
* Brigatinib
* Ceritinib
* Crizotinib

RET inhibitors: Vandetanib (also VEGFR and EGFR). Entrectinib (ALK, ROS1, NTRK). c-MET inhibitor: Cabozantinib (also VEGFR2).

|

Non-receptor|

* bcr-abl
* Bosutinib
* Dasatinib
* Imatinib
* Nilotinib
* Ponatinib
* Radotinib

* Src (Bosutinib
* Dasatinib)

* Janus kinase
* Lestaurtinib
* Momelotinib
* Pacritinib
* Ruxolitinib

* MAP2K
* Binimetinib
* Cobimetinib
* Selumetinib
* Trametinib

* EML4-ALK
* Crizotinib
* Entrectinib
* Lorlatinib

* Bruton's
* Acalabrutinib
* Ibrutinib

Other|

* fusion protein against VEGF (Aflibercept)
* proapoptotic peptide against ANXA2 and prohibitin (Adipotide)
* exotoxin against IL-2 (Denileukin diftitox)
* mTOR inhibitors
* Everolimus
* Temsirolimus
* hedgehog inhibitors
* Sonidegib
* Vismodegib
* CDK inhibitor (Palbociclib
* Ribociclib)

* v
* t
* e

Pharmacology: enzyme inhibition

Class|

* Competitive inhibition
* Uncompetitive inhibition
* Non-competitive inhibition
* Suicide inhibition
* Mixed inhibition

Substrate|

| Oxidoreductase (EC 1)|

* 1.1 Aldose reductase
* HMG-CoA reductase

* 1.3 5α-Reductase

* 1.4 Monoamine oxidase

* 1.5 Dihydrofolate reductase

* 1.13 Lipoxygenase

* 1.14 Aromatase
* COX-2

* 1.17 Xanthine oxidase
* Ribonucleotide reductase

|

Transferase (EC 2)|

* 2.1 COMT
* Thymidylate synthase

* 2.4 PARP

* 2.5 Dihydropteroate synthetase
* Farnesyltransferase

* 2.6 GABA transaminase

* 2.7 Nucleotidyltransferase
* Integrase
* Reverse transcriptase
* Protein kinase
* Tyrosine kinase
* Janus kinase

Hydrolase (EC 3)|

* 3.1 Phosphodiesterase
* Acetylcholinesterase
* Ribonuclease

* 3.2 Polygalacturonase
* Neuraminidase
* Alpha-glucosidase

* 3.4 Protease: Exopeptidase
* DPP-4
* ACE
* Endopeptidase
* Trypsin
* Renin
* Mixed
* Enkephalinase
* Matrix metalloproteinase
* Oxytocinase

* 3.5 Histone deacetylase
* Beta-lactamase

Lyase (EC 4)|

* 4.1 Dopa decarboxylase

* 4.2 Carbonic anhydrase

Miscellaneous|

* Steroidogenesis inhibitor

* v
* t
* e

Growth factor receptor modulators

Angiopoietin|

* Agonists: Angiopoietin 1
* Angiopoietin 4

* Antagonists: Angiopoietin 2
* Angiopoietin 3

* Kinase inhibitors: Altiratinib
* CE-245677
* Rebastinib

* Antibodies: Evinacumab (against angiopoietin 3)
* Nesvacumab (against angiopoietin 2)

CNTF|

* Agonists: Axokine
* CNTF
* Dapiclermin

EGF (ErbB)|

| EGF
(ErbB1/HER1)|

* Agonists: Amphiregulin
* Betacellulin
* EGF (urogastrone)
* Epigen
* Epiregulin
* Heparin-binding EGF-like growth factor (HB-EGF)
* Murodermin
* Nepidermin
* Transforming growth factor alpha (TGFα)

* Kinase inhibitors: Afatinib
* AG-490
* Agerafenib
* Brigatinib
* Canertinib
* Dacomitinib
* Erlotinib
* Gefitinib
* Grandinin
* Icotinib
* Lapatinib
* Neratinib
* Osimertinib
* Vandetanib
* WHI-P 154

* Antibodies: Cetuximab
* Depatuxizumab
* Depatuxizumab mafodotin
* Futuximab
* Imgatuzumab
* Matuzumab
* Necitumumab
* Nimotuzumab
* Panitumumab
* Zalutumumab

|

ErbB2/HER2|

* Agonists: Unknown/none

* Antibodies: Ertumaxomab
* Pertuzumab
* Trastuzumab
* Trastuzumab duocarmazine
* Trastuzumab emtansine

* Kinase inhibitors: Afatinib
* AG-490
* Lapatinib
* Mubritinib
* Neratinib

ErbB3/HER3|

* Agonists: Neuregulins (heregulins) (1, 2, 6 (neuroglycan C))

* Antibodies: Duligotumab
* Patritumab
* Seribantumab

ErbB4/HER4|

* Agonists: Betacellulin
* Epigen
* Heparin-binding EGF-like growth factor (HB-EGF)
* Neuregulins (heregulins) (1, 2, 3, 4, 5 (tomoregulin, TMEFF))

FGF|

| FGFR1|

* Agonists: Ersofermin
* FGF (1, 2 (bFGF), 3, 4, 5, 6, 8, 10 (KGF2), 20)
* Repifermin
* Trafermin
* Velafermin

|

FGFR2|

* Agonists: Ersofermin
* FGF (1, 2 (bFGF), 3, 4, 5, 6, 7 (KGF), 8, 9, 10 (KGF2), 17, 18, 22)
* Palifermin
* Repifermin
* Sprifermin
* Trafermin

* Antibodies: Aprutumab
* Aprutumab ixadotin

FGFR3|

* Agonists: Ersofermin
* FGF (1, 2 (bFGF), 4, 8, 9, 18, 23)
* Sprifermin
* Trafermin

* Antibodies: Burosumab (against FGF23)

FGFR4|

* Agonists: Ersofermin
* FGF (1, 2 (bFGF), 4, 6, 8, 9, 19)
* Trafermin

Unsorted|

* Agonists: FGF15/19

HGF (c-Met)|

* Agonists: Hepatocyte growth factor

* Potentiators: Dihexa (PNB-0408)

* Kinase inhibitors: Altiratinib
* AM7
* AMG-458
* Amuvatinib
* BMS-777607
* Cabozantinib
* Crizotinib
* Foretinib
* Golvatinib
* INCB28060
* JNJ-38877605
* K252a
* MK-2461
* PF-04217903
* PF-2341066
* PHA-665752
* SU-11274
* Tivantinib
* Volitinib

* Antibodies: Emibetuzumab
* Ficlatuzumab
* Flanvotumab
* Onartuzumab
* Rilotumumab
* Telisotuzumab
* Telisotuzumab vedotin

IGF|

| IGF-1|

* Agonists: des(1-3)IGF-1
* Insulin-like growth factor-1 (somatomedin C)
* IGF-1 LR3
* Insulin-like growth factor-2 (somatomedin A)
* Insulin
* Mecasermin
* Mecasermin rinfabate

* Kinase inhibitors: BMS-754807
* Linsitinib
* NVP-ADW742
* NVP-AEW541
* OSl-906

* Antibodies: AVE-1642
* Cixutumumab
* Dalotuzumab
* Figitumumab
* Ganitumab
* Robatumumab
* R1507
* Teprotumumab
* Xentuzumab (against IGF-1 and IGF-2)

|

IGF-2|

* Agonists: Insulin-like growth factor-2 (somatomedin A)

* Antibodies: Dusigitumab
* Xentuzumab (against IGF-1 and IGF-2)

Others|

* Binding proteins: IGFBP (1, 2, 3, 4, 5, 6, 7)

* Cleavage products/derivatives with unknown target: Glypromate (GPE, (1-3)IGF-1)
* Trofinetide

LNGF (p75NTR)|

* Agonists: BDNF
* BNN-20
* BNN-27
* Cenegermin
* DHEA
* DHEA-S
* NGF
* NT-3
* NT-4

* Antagonists: ALE-0540
* Dexamethasone
* EVT-901 (SAR-127963)
* Testosterone

* Antibodies: Against NGF: ABT-110 (PG110)
* ASP-6294
* Fasinumab
* Frunevetmab
* Fulranumab
* MEDI-578
* Ranevetmab
* Tanezumab

* Aptamers: Against NGF: RBM-004

* Decoy receptors: LEVI-04 (p75NTR-Fc)

PDGF|

* Agonists: Becaplermin
* Platelet-derived growth factor (A, B, C, D)

* Kinase inhibitors: Agerafenib
* Axitinib
* Crenolanib
* Imatinib
* Lenvatinib
* Masitinib
* Motesanib
* Nintedanib
* Pazopanib
* Radotinib
* Quizartinib
* Sunitinib
* Sorafenib
* Toceranib

* Antibodies: Olaratumab
* Ramucirumab
* Tovetumab

RET (GFL)|

| GFRα1|

* Agonists: Glial cell line-derived neurotrophic factor (GDNF)
* Liatermin

* Kinase inhibitors: Vandetanib

|

GFRα2|

* Agonists: Neurturin (NRTN)

* Kinase inhibitors: Vandetanib

GFRα3|

* Agonists: Artemin (ARTN)

* Kinase inhibitors: Vandetanib

GFRα4|

* Agonists: Persephin (PSPN)

* Kinase inhibitors: Vandetanib

Unsorted|

* Kinase inhibitors: Agerafenib

SCF (c-Kit)|

* Agonists: Ancestim
* Stem cell factor

* Kinase inhibitors: Agerafenib
* Axitinib
* Dasatinib
* Imatinib
* Masitinib
* Nilotinib
* Pazopanib
* Quizartinib
* Sorafenib
* Sunitinib
* Toceranib

TGFβ|

* See here instead.

Trk|

| TrkA|

* Agonists: Amitriptyline
* BNN-20
* BNN-27
* Cenegermin
* DHEA
* DHEA-S
* Gambogic amide
* NGF
* Tavilermide

* Antagonists: ALE-0540
* Dexamethasone
* FX007
* Testosterone

* Negative allosteric modulators: VM-902A

* Kinase inhibitors: Altiratinib
* AZD-6918
* CE-245677
* CH-7057288
* DS-6051
* Entrectinib
* GZ-389988
* K252a
* Larotrectinib
* Lestaurtinib
* Milciclib
* ONO-4474
* ONO-5390556
* PLX-7486
* Rebastinib
* SNA-120 (pegylated K252a))

* Antibodies: Against TrkA: GBR-900; Against NGF: ABT-110 (PG110)
* ASP-6294
* Fasinumab
* Frunevetmab
* Fulranumab
* MEDI-578
* Ranevetmab
* Tanezumab

* Aptamers: Against NGF: RBM-004

* Decoy receptors: ReN-1820 (TrkAd5)

|

TrkB|

* Agonists: 3,7-DHF
* 3,7,8,2'-THF
* 4'-DMA-7,8-DHF
* 7,3'-DHF
* 7,8-DHF
* 7,8,2'-THF
* 7,8,3'-THF
* Amitriptyline
* BDNF
* BNN-20
* Deoxygedunin
* Deprenyl
* Diosmetin
* DMAQ-B1
* HIOC
* LM22A-4
* N-Acetylserotonin
* NT-3
* NT-4
* Norwogonin (5,7,8-THF)
* R7
* R13
* TDP6

* Antagonists: ANA-12
* Cyclotraxin B
* Gossypetin (3,5,7,8,3',4'-HHF)

* Ligands: DHEA

* Kinase inhibitors: Altiratinib
* AZD-6918
* CE-245677
* CH-7057288
* DS-6051
* Entrectinib
* GZ-389988
* K252a
* Larotrectinib
* Lestaurtinib
* ONO-4474
* ONO-5390556
* PLX-7486

TrkC|

* Agonists: BNN-20
* DHEA
* NT-3

* Kinase inhibitors: Altiratinib
* AZD-6918
* CE-245677
* CH-7057288
* DS-6051
* Entrectinib
* GZ-389988
* K252a
* Larotrectinib
* Lestaurtinib
* ONO-4474
* ONO-5390556
* PLX-7486

VEGF|

* Agonists: Placental growth factor (PGF)
* Telbermin
* VEGF (A, B, C, D (FIGF))

* Allosteric modulators: Cyclotraxin B

* Kinase inhibitors: Agerafenib
* Altiratinib
* Axitinib
* Cabozantinib
* Cediranib
* Lapatinib
* Lenvatinib
* Motesanib
* Nintedanib
* Pazopanib
* Pegaptanib
* Rebastinib
* Regorafenib
* Semaxanib
* Sorafenib
* Sunitinib
* Toceranib
* Tivozanib
* Vandetanib
* WHI-P 154

* Antibodies: Alacizumab pegol
* Bevacizumab
* Icrucumab
* Ramucirumab
* Ranibizumab

* Decoy receptors: Aflibercept

Others|

* Additional growth factors: Adrenomedullin
* Colony-stimulating factors (see here instead)
* Connective tissue growth factor (CTGF)
* Ephrins (A1, A2, A3, A4, A5, B1, B2, B3)
* Erythropoietin (see here instead)
* Glucose-6-phosphate isomerase (GPI; PGI, PHI, AMF)
* Glia maturation factor (GMF)
* Hepatoma-derived growth factor (HDGF)
* Interleukins/T-cell growth factors (see here instead)
* Leukemia inhibitory factor (LIF)
* Macrophage-stimulating protein (MSP; HLP, HGFLP)
* Midkine (NEGF2)
* Migration-stimulating factor (MSF; PRG4)
* Oncomodulin
* Pituitary adenylate cyclase-activating peptide (PACAP)
* Pleiotrophin
* Renalase
* Thrombopoietin (see here instead)
* Wnt signaling proteins

* Additional growth factor receptor modulators: Cerebrolysin (neurotrophin mixture)

See also
Receptor/signaling modulators
Signaling peptide/protein receptor modulators
Cytokine receptor modulators

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