Iruplinalkib (WX‑0593), a novel ALK/ROS1 inhibitor, overcomes crizotinib resistance in preclinical models for non-small cell lung cancer

Invest New Drugs. 2023 Apr;41(2):254-266. doi: 10.1007/s10637-023-01350-x. Epub 2023 Apr 10.


Despite remarkable initial responses of anaplastic lymphoma kinase (ALK) inhibitors in ALK-positive non-small cell lung cancer (NSCLC) patients, cancers eventually develop resistance within one to two years. This study aimed to compare the properties of iruplinalkib (WX‑0593) with other ALK inhibitors and report the comprehensive characterization of iruplinalkib against the crizotinib resistance. The inhibitory effect of iruplinalkib on kinase activity was detected. A kinase screen was performed to evaluate the selectivity of iruplinalkib. The effect of iruplinalkib on related signal transduction pathways of ALK and c-ros oncogene 1 (ROS1) kinases was examined. The cellular and in vivo activities of ALK inhibitors were compared in engineered cancer-derived cell lines and in mice xenograft models, respectively. Human hepatocytes derived from three donors were used for evaluating hepatic enzyme inducing activity. HEK293 cell lines expressing transportors were used to invesigated the drug interaction potential mediated by several transporters. The results showed iruplinalkib potently inhibited the tyrosine autophosphorylation of wild-type ALK, ALKL1196M, ALKC1156Y and epidermal growth factor receptor (EGFR)L858R/T790M. The inhibitory effects of iruplinalkib in patient-derived xenograft and cell line-derived xenograft models were observed. Moreover, iruplinalkib showed robust antitumor effects in BALB/c nude mice xenograft models with ALK-/ROS1-positive tumors implanted subcutaneously, and the tumor suppressive effects in crizotinib-resistant model was significantly better than that of brigatinib. Iruplinalkib did not induce CYP1A2, CYP2B6 and CYP3A4 at therapeutic concentration, and was also a strong inhibitor of MATE1 and MATE2K transporters, as well as P-gp and BCRP. In conclusion, iruplinalkib, a highly active and selective ALK/ROS1 inhibitor, exhibited strong antitumor effects in vitro and in crizotinib-resistant models.

Keywords: Anaplastic lymphoma kinase; Crizotinib resistance; Iruplinalkib; Non-small cell lung cancer; Resistance mechanisms; Tyrosine kinase inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily G, Member 2
  • Anaplastic Lymphoma Kinase / metabolism
  • Animals
  • Carcinoma, Non-Small-Cell Lung* / pathology
  • Cell Line, Tumor
  • Crizotinib / pharmacology
  • Crizotinib / therapeutic use
  • Drug Resistance, Neoplasm
  • ErbB Receptors / genetics
  • HEK293 Cells
  • Humans
  • Lung Neoplasms* / pathology
  • Mice
  • Mice, Nude
  • Mutation
  • Neoplasm Proteins / metabolism
  • Oncogenes
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use
  • Protein-Tyrosine Kinases
  • Proto-Oncogene Proteins
  • Pyridines / therapeutic use
  • Receptor Protein-Tyrosine Kinases


  • Crizotinib
  • Protein Kinase Inhibitors
  • Protein-Tyrosine Kinases
  • ErbB Receptors
  • ATP Binding Cassette Transporter, Subfamily G, Member 2
  • Receptor Protein-Tyrosine Kinases
  • Anaplastic Lymphoma Kinase
  • Pyridines
  • Proto-Oncogene Proteins
  • Neoplasm Proteins
  • ROS1 protein, human