Oral epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of non-small cell lung cancer: Comparative pharmacokinetics and drug–drug interactions
Open accessAbstract
The development of orally active small molecule inhibitors of the epidermal growth factor receptor (EGFR) has led to new treatment options for non-small cell lung cancer (NSCLC). Patients with activating mutations of the EGFR gene show sensitivity to, and clinical benefit from, treatment with EGFR tyrosine kinase inhibitors (EGFR-TKls). First generation reversible ATP-competitive EGFR-TKls, gefitinib and erlotinib, are effective as first, second-line or maintenance therapy. Despite initial benefit, most patients develop resistance within a year, 50-60% of cases being related to the appearance of a T790M gatekeeper mutation. Newer, irreversible EGFR-TKls - afatinib and dacomitinib - covalently bind to and inhibit multiple receptors in the ErbB family (EGFR, HER2 and HER4). These agents have been mainly evaluated for first-line treatment but also in the setting of acquired resistance to first-generation EGFR-TKls. Afatinib is the first ErbB family blocker approved for patients with NSCLC with activating EGFR mutations; dacomitinib is in late stage clinical development. Mutant-selective EGFR inhibitors (AZD9291, CO-1686, HM61713) that specifically target the T790M resistance mutation are in early development. The EGFR-TKIs differ in their spectrum of target kinases, reversibility of binding to EGFR receptor, pharmacokinetics and potential for drug-drug interactions, as discussed in this review. For the clinician, these differences are relevant in the setting of polymedicated patients with NSCLC, as well as from the perspective of innovative anticancer drug combination strategies.
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Afatinib is highly soluble across the physiological pH range of 1-7.5 and is not expected to interact with acid-reducing agents.
“Afatinib is highly soluble across the physiological pH range of 1–7.5 and is not expected to interact with acid-reducing agents.”
From Afatinib for the treatment of <i>EGFR</i> mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [61]
CYP enzymes play a negligible role in the metabolism of afatinib.
“CYP enzymes play a negligible role in the metabolism of afatinib.”
From Afatinib for the treatment of <i>EGFR</i> mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [61]
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- Authors
- Peters, S., Zimmermann, S., & Adjei, A. A.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- Roswell Park Comprehensive Cancer Center (US)
- Corresponding author
- Peters, Solange
- Venue
- Cancer Treatment Reviews
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 40
- Issue
- 8
- Pages
- 917-926
- ISSN
- 0305-7372 (ISSN-L)
- OpenAlex
- W2097781997
- Cited by
- 155
- References
- 115
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 10 · 2023: 9 · 2022: 14 · 2021: 12 · 2020: 10 · 2019: 24 · 2018: 10 · 2017: 18 · 2016: 16 · 2015: 16 · 2014: 1
- FWCI
- 13.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cancer Treatment Reviews (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- EGFR tyrosine kinase inhibitors, non-small cell lung cancer, gefitinib, erlotinib, afatinib, dacomitinib, T790M mutation, acquired drug resistance, pharmacokinetics, drug-drug interactions, ErbB family, mutant-selective inhibitors, oral anticancer drugs, combination therapy
- MeSH terms
- Administration, Oral, Carcinoma, Non-Small-Cell Lung, Drug Interactions, Humans, Lung Neoplasms, Protein Kinase Inhibitors, ErbB Receptors
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