Protein kinase inhibitor
Enzymes that block actions of protein kinases
A protein kinase inhibitor (PKI ) is a type of enzyme inhibitor that blocks the action of one or more protein kinases . Protein kinases are enzymes that phosphorylate (add a phosphate , or PO4 , group) to a protein and can modulate its function.
The phosphate groups are usually added to serine , threonine , or tyrosine amino acids on the protein. Most kinases act on both serine and threonine, the tyrosine kinases act on tyrosine, and a number (dual-specificity kinases ) act on all three. There are also protein kinases that phosphorylate other amino acids, including histidine kinases that phosphorylate histidine residues.[citation needed ]
Phosphorylation regulates many biological processes, and protein kinase inhibitors can be used to treat diseases due to hyperactive protein kinases (including mutant or overexpressed kinases in cancer) or to modulate cell functions to overcome other disease drivers.
Clinical use
Kinase inhibitors such as dasatinib are often used in the treatment of cancer and inflammation .[ 1]
Some of the kinase inhibitors used in treating cancer are inhibitors of tyrosine kinases .[ 2]
The effectiveness of kinase inhibitors on various cancers can vary from patient to patient.[ 3]
Examples
There are several drugs launched or in development that target protein kinases and the receptors that activate them:
Comparison of available agents
Comparison of available agents used as Human Medicines
Drug
Sponsor
Target
Indications
Major toxicities
Black box warning(s)
MS[ Note 1] [ 8]
D
FR
PC (AU)[ Note 2]
PC (US)[ Note 2]
FDA AD[ 9]
EMA AD[ 10]
TGA AD[ 11]
Afatinib
Boehringer Ingelheim
ErbB family (irreversible)
Advanced non-small cell lung cancer
Hepatotoxicity, kidney failure, electrolyte anomalies (mostly hypokalaemia ) and interstitial lung disease (uncommon).
None
-
+++
-
C
D
12 July 2013
25 September 2013
7 November 2013
Aflibercept
Bayer , Regeneron Pharmaceuticals
VEGF
Advanced colorectal cancer and wet macular degeneration .
GI perforation, haemorrhage and hepatotoxicity
None
+++/++
+++/++
-
D
C
21 November 2011
22 November 2012
2 April 2013
Axitinib
Pfizer
VEGFR , PDGFR , c-KIT
Renal cell carcinoma
Thyroid dysfunction, blood clots, haemorrhages, reversible posterior leucoencephalopathy syndrome (uncommon), GI perforation/fistula (uncommon) and electrolyte disturbances
None
++
++
-
D
D
27 January 2012
3 September 2012
26 July 2012
Bevacizumab
Genentech
VEGF
Colorectal cancer , breast cancer , non-small cell lung cancer , renal cell carcinoma , macular degeneration and glioblastoma
Hypertension, GI perforation, ovarian failure, GI haemorrhage, blood clots, electrolyte anomalies, ileus , congestive heart failure , osteonecrosis of the jaw (rare), necrotising fasciitis (rare), gallbladder perforation (rare)
GI perforation, haemorrhage and wound healing complications
++
++/+
-
D
C
26 February 2004
12 January 2005
24 February 2005
Bosutinib
Pfizer
Bcr-Abl
Second-line Chronic myelogenous leukaemia treatment
Lower respiratory tract infection, anaphylaxis (uncommon), electrolyte anomalies, cardiovascular effects (especially QT interval prolongation), GI haemorrhage (uncommon), hepatotoxicity and kidney failure.
None
++/+
+++
+
N/A
D
4 September 2012
27 March 2013
N/A
Cabozantinib
Exelixis
c-Met , VEGFR2
Metastatic thyroid cancer
Electrolyte anomalies, hypotension, peripheral sensory neuropathy, GI perforation/fistula, reversible posterior leucoencephalopathy syndrome (rare), blood clots and osteonecrosis .
GI haemorrhage, perforation and fistula
++
+++/++
-
N/A
D
29 November 2012
N/A
N/A
Crizotinib
Pfizer
ALK , HGFR , c-MET
Anaplastic lymphoma kinase -positive non-small cell lung cancer
Peripheral neuropathy, electrolyte anomalies, blood clots, kidney cyst, liver failure, interstitial lung disease and cardiotoxicity (probably QT interval prolongation).
None
++
++
++/+
D
D
26 August 2011
23 October 2012
27 September 2013
Dacomitinib
Pfizer
ErbB family (irreversible)
Advanced non-small cell lung cancer
Diarrhea, rash, fatigue.
None
N/A
N/A
N/A
N/A
N/A
27 September 2018
2 April 2019
-
Dasatinib
Bristol-Myers Squibb
Bcr-Abl , Src , c-KIT
Second-line Chronic myelogenous leukaemia treatment
Electrolyte disturbances, haemorrhages, fluid retention, heart failure (uncommon), myocardial infarction (uncommon) and pulmonary hypertension
None
+/-
++
++
D
D
28 June 2006
20 November 2006
15 January 2007
Erlotinib
Roche
EGFR
Advanced non-small cell lung cancer and pancreatic cancer
GI bleeds (rare), liver failure (rare), hepatorenal syndrome (rare), EGFR skin reactions and interstitial lung disease (uncommon).
None
-
+++/++
-
C
D
18 November 2004
19 September 2005
30 January 2006
Gefitinib
AstraZeneca , Teva
EGFR
Advanced non-small cell lung cancer with EGFR mutation
Haemorrhage, EGFR skin reactions (including Stevens–Johnson syndrome [SJS; rare] and toxic epidermal necrolysis [TEN; rare]), liver failure (rare), hepatitis (uncommon), pancreatitis (uncommon) and interstitial lung disease (uncommon).
N/A
-
+++/++
-
C
D
5 May 2003 (discontinued)
24 June 2009
7 September 2011
Imatinib
Novartis
Bcr-Abl
First-line chronic myelogenous leukaemia treatment
Haemorrhage, electrolyte disturbances, cardiotoxicity (uncommon), kidney failure (uncommon), GI perforation, hepatotoxicity (rare) and rhabdomyolysis (rare)
N/A
+++/++
+
++
D
D
10 May 2001
7 November 2001
13 August 2001
Lapatinib
GlaxoSmithKline
HER2
HER2-positive advanced breast cancer
Hypersensitivity (rare), hepatotoxicity (uncommon), interstitial lung disease (uncommon) and cardiovascular problems.
Hepatotoxicity
-
++
-
C
D
13 March 2007
10 June 2008
28 June 2007
Nilotinib
Novartis
Bcr-Abl
Second-line chronic myelogenous leukaemia treatment
Hyperglycaemia, electrolyte disturbances, fluid retention, pancreatitis and cardiotoxicity (mostly QT interval prolongation).
QT interval prolongation and electrolyte anomalies
++
+
+
D
D
29 October 2007
2 June 2009
17 January 2008
Panitumumab
Amgen
EGFR
Colorectal cancer
Electrolyte anomalies, anaphylaxis, blood clots, sepsis and pulmonary fibrosis.
Dermatologic reactions and infusion reactions
-
+
+
C
C
10 October 2006
3 December 2007
20 March 2012
Pazopanib
GlaxoSmithKline
VEGFR , PDGFR , c-KIT
Renal cell carcinoma and soft tissue sarcoma
Cardiotoxicity (mostly QT interval prolongation but also heart failure [uncommon]), blood clots, haemorrhage, thyroid anomalies (mostly hypothyroidism), blood glucose anomalies (hypoglycaemia and hyperglycaemia ), torsades de pointes (uncommon), hepatotoxicity (uncommon), GI perforation/fistula (uncommon) and reversible posterior leucoencephalopathy syndrome (rare).
Hepatotoxicity
-
++
-
D
D
19 October 2009
14 June 2010
30 June 2010
Pegaptanib
OSI , Pfizer
VEGF
Wet macular degeneration
Hypertension, cataracts, haemorrhage, vitreous floater, transient ischaemic attack , retinal detachment, diabetes mellitus and urinary tract infection
None
-
+/-
++
N/A
B
17 December 2004
31 January 2006
N/A
Ponatinib
ARIAD Pharmaceuticals
Bcr-Abl , BEGFR, PDGFR , FGFR , EPH , SRC , c-KIT , RET , TIE2 , FLT3
T315I-positive Chronic myelogenous leukaemia and T315I-positive-Acute lymphoblastic leukaemia
Hypertension, pneumonia, urinary tract infection, sepsis, GI haemorrhage, liver failure, cardiovascular problems and blood clots.
Liver failure, blood clots and hepatotoxicity
++
+
+
N/A
D
14 December 2012
1 July 2013
N/A
Ranibizumab
Novartis
VEGF-A
Wet macular degeneration and macular oedema (including diabetic macular oedema)
Haemorrhage (conjunctival, vitreous and injection site), increased intraocular pressure, vitreous detachment and retinal degeneration.
None
-
-
-
D
C
10 August 2012
22 January 2007
27 February 2007
Regorafenib
Bayer
RET , VEGFR , PDGFR
Advanced colorectal cancer , gastrointestinal stromal tumours
Electrolyte anomalies, hepatotoxicity, hypotension, haemorrhage, GI fistula, thyroid problems and blood clots.
Hepatotoxicity
+++/++
++
-
D
D
27 September 2012
26 August 2013
29 November 2013
Ruxolitinib
Novartis
JAK
Myelofibrosis
Hypercholesterolaemia , urinary tract infection , herpes zoster , tuberculosis and hepatotoxicity
None
+++
-
-
C
C
16 November 2011
23 August 2012
3 July 2013
Sorafenib
Bayer
VEGFR , PDGFR , BRAF , c-KIT , etc.
Advanced Renal cell carcinoma and Hepatocellular carcinoma
Hypertension, peripheral neuropathy, thyroid dysfunction, cardiovascular problems (e.g. QT interval prolongation, heart attack or heart failure), electrolyte anomalies, GI perforation (uncommon), pancreatitis (uncommon), hepatitis (rare), nephrotic syndrome (rare) and reversible posterior leucoencephalopathy syndrome (rare)
None
++
++
-
D
D
20 December 2005
19 July 2006
27 September 2006
Sunitinib
Pfizer
VEGFR , PDGFR
Renal cell carcinoma , GI stromal tumour, pancreatic neuroendocrine tumour
Blood clots, cardiovascular problems (mostly heart failure or left ventricular dysfunction but also QT interval prolongation and torsades de pointes), thyroid dysfunction, electrolyte anomalies, skin reactions (including SJS [rare] and TEN [rare]), liver failure (uncommon) and pancreatitis (uncommon).
Hepatotoxicity
+
++
+
D
D
26 January 2006
19 July 2006
14 September 2006
Tofacitinib
Pfizer
JAK
Rheumatoid arthritis
Infections and malignancies
Serious infections and malignancies
-
-
-
N/A
C
6 November 2012
N/A; refused 26 April 2013
N/A
Trastuzumab
Genentech
HER2
Breast cancer (for either metastatic disease or adjuvant treatment), metastatic gastric cancer
Congestive heart failure , depression, pulmonary toxicity, infections and tachycardia (heart high rate)
Pulmonary toxicity, cardiomyopathy and a confusion warning
-
+
+
B2
D
25 September 1998
28 August 2000
14 September 2000
Tucatinib
Seattle Genetics
HER2
Advanced unresectable or metastatic HER2-positive breast cancer
Diarrhea, hepatotoxicity, embryo-fetal toxicity
None
April 2020
August 2020
Vandetanib
AstraZeneca
VEGFR , EGFR , RET , BRK
Advanced medullary thyroid cancer
Urinary tract infection , hypertension , QT interval prolongation, electrolyte anomalies, depression, GI perforation and thyroid anomalies
QT interval prolongation
-
++
-
D
D
21 April 2011
17 February 2012
31 January 2013
Vemurafenib
Roche
BRAF
Metastatic malignant melanoma
Photosensitivity , squamous cell carcinoma and hepatotoxicity
None
-
+
+
D
D
17 August 2011
10 May 2012
17 February 2012
Note:
AD = Approval date.
MS = Myelosuppression.
D = Diarrhoea.
FR = Fluid retention.
As far as myelosuppression, diarrhoea and fluid retention goes: +++ means >70% of patients exhibit clinically significant myelosuppression. ++ means 30-70% of patients exhibit significant myelosuppression. + means 10-30% of patients exhibit significant myelosuppression. - means 0-10% of patients exhibit this side effect.
General references templates are given, which refer the reader to the respective drug database.
^ Myelosuppression.
^ a b PC = Pregnancy category
See also
References
^ Gross S, Rahal R, Stransky N, Lengauer C, Hoeflich KP (May 2015). "Targeting cancer with kinase inhibitors" . The Journal of Clinical Investigation . 125 (5): 1780– 1789. doi :10.1172/JCI76094 . PMC 4463189 . PMID 25932675 .
^ "Definition of tyrosine kinase inhibitor - NCI Dictionary of Cancer Terms" . Archived from the original on 2008-05-11.
^ Jänne, Pasi A.; Gray, Nathanael; Settleman, Jeff (2009). "Factors underlying sensitivity of cancers to small-molecule kinase inhibitors". Nature Reviews Drug Discovery . 8 (9): 709– 23. doi :10.1038/nrd2871 . PMID 19629074 . S2CID 7817325 .
^ "Clinical trials using WEE1 inhibitor AZD1775" . National Cancer Institute . Retrieved April 20, 2018 .
^ "Janssen announces U.S. FDA breakthrough therapy designation for erdafitinib in the Treatment of metastatic urothelial cancer" . Johnson and Johnson . March 15, 2018. Retrieved April 20, 2018 .
^ Bajpai, M (2009). "Fostamatinib, a Syk inhibitor prodrug for the treatment of inflammatory diseases". IDrugs . 12 (3): 174– 85. PMID 19333898 .
^ "FDA Grants Imatinib (Gleevec) Full Approval for Adjuvant Treatment of GIST" .
^ "Medscape Multispecialty – Home page" . WebMD . Retrieved 27 November 2013 .[full citation needed ]
^ Monograph
^ "European Public Assessment Reports" . European Medicines Agency . Archived from the original on 4 February 2014. Retrieved 27 January 2014 .[full citation needed ]
^ "Therapeutic Goods Administration – Home page" . Department of Health (Australia) . Retrieved 27 November 2013 .[full citation needed ]
Further reading
Attwood MM, Fabbro D, Sokolov AV, Knapp S, Schiöth HB (November 2021). "Trends in kinase drug discovery: targets, indications and inhibitor design". Nature Reviews. Drug Discovery . 20 (11): 839– 861. doi :10.1038/s41573-021-00252-y . PMID 34354255 . S2CID 236935403 .
Ayala-Aguilera CC, Valero T, Lorente-Macías Á, Baillache DJ, Croke S, Unciti-Broceta A (January 2022). "Small Molecule Kinase Inhibitor Drugs (1995-2021): Medical Indication, Pharmacology, and Synthesis" (PDF) . Journal of Medicinal Chemistry . 65 (2): 1047– 1131. doi :10.1021/acs.jmedchem.1c00963 . PMID 34624192 . S2CID 238528289 .
Carles F, Bourg S, Meyer C, Bonnet P (April 2018). "PKIDB: A Curated, Annotated and Updated Database of Protein Kinase Inhibitors in Clinical Trials" . Molecules (Basel, Switzerland) . 23 (4): 908. doi :10.3390/molecules23040908 . PMC 6017449 . PMID 29662024 .
Jänne PA, Gray N, Settleman J (September 2009). "Factors underlying sensitivity of cancers to small-molecule kinase inhibitors". Nature Reviews. Drug Discovery . 8 (9): 709– 23. doi :10.1038/nrd2871 . PMID 19629074 . S2CID 7817325 .
Roskoski R (March 2021). "Properties of FDA-approved small molecule protein kinase inhibitors: A 2021 update". Pharmacological Research . 165 : 105463. doi :10.1016/j.phrs.2021.105463 . PMID 33513356 . S2CID 231770008 .
External links
CI monoclonal antibodies ("-mab")
Tyrosine kinase inhibitors ("-nib")
Receptor tyrosine kinase
RET inhibitors: Entrectinib (ALK, ROS1, NTRK), Futibatinib (FGFR2), Infigratinib , Larotrectinib (NTRK), Pemigatinib (FGFR), Pralsetinib , Repotrectinib (ROS1, TRK, ALK), Selpercatinib (VEGFR, FGFR), Vandetanib (VEGFR, EGFR).
Non-receptor
Other