Remodeling of the tumor/tumor microenvironment ecosystem during KRAS G12C inhibitor clinical resistance in lung cancer

J Clin Invest. 2022 Feb 15;132(4):e156891. doi: 10.1172/JCI156891.

Abstract

KRAS G12C inhibitors such as sotorasib and adagrasib are often effective in KRAS G12C-driven non-small cell lung cancer (NSCLC) patients. However, acquired resistance limits long-term patient survival. In this issue of the JCI, Tsai et al. present a comprehensive genetic analysis of multiple tumors with acquired sotorasib resistance obtained through an autopsy of a patient with KRAS G12C-mutant NSCLC. This analysis of pre- and posttreatment tumors uncovered cancer cell-intrinsic and -extrinsic features of resistance, including reactivation of KRAS-mediated signaling, reprogramming of metabolism, epithelial-mesenchymal transition, and tumor microenvironment changes. This elegant study demonstrates the multifaceted nature of KRAS G12C inhibitor clinical resistance and potential avenues to overcome resistance.

Publication types

  • Research Support, N.I.H., Extramural
  • Comment

MeSH terms

  • Acetonitriles
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • Ecosystem
  • Humans
  • Lung Neoplasms* / drug therapy
  • Lung Neoplasms* / genetics
  • Piperazines
  • Proto-Oncogene Proteins p21(ras) / genetics
  • Pyrimidines
  • Tumor Microenvironment / genetics

Substances

  • Acetonitriles
  • KRAS protein, human
  • Piperazines
  • Pyrimidines
  • adagrasib
  • Proto-Oncogene Proteins p21(ras)