title: Structural insight into selectivity and resistance profiles of ROS1 tyrosine kinase inhibitors.
abstract: Oncogenic ROS1 fusion proteins are molecular drivers in multiple malignancies, including a subset of non-small cell lung cancer (NSCLC). The phylogenetic proximity of the ROS1 and anaplastic lymphoma kinase (ALK) catalytic domains led to the clinical repurposing of the Food and Drug Administration (FDA)-approved ALK inhibitor crizotinib as a ROS1 inhibitor. Despite the antitumor activity of crizotinib observed in both ROS1- and ALK-rearranged NSCLC patients, resistance due to acquisition of ROS1 or ALK kinase domain mutations has been observed clinically, spurring the development of second-generation inhibitors. Here, we profile the sensitivity and selectivity of seven ROS1 and/or ALK inhibitors at various levels of clinical development. In contrast to crizotinib's dual ROS1/ALK activity, cabozantinib (XL-184) and its structural analog foretinib (XL-880) demonstrate a striking selectivity for ROS1 over ALK. Molecular dynamics simulation studies reveal structural features that distinguish the ROS1 and ALK kinase domains and contribute to differences in binding site and kinase selectivity of the inhibitors tested. Cell-based resistance profiling studies demonstrate that the ROS1-selective inhibitors retain efficacy against the recently reported CD74-ROS1(G2032R) mutant whereas the dual ROS1/ALK inhibitors are ineffective. Taken together, inhibitor profiling and stringent characterization of the structure-function differences between the ROS1 and ALK kinase domains will facilitate future rational drug design for ROS1- and ALK-driven NSCLC and other malignancies.
authors.affiliation: Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239; Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239;
authors.forename: Monika A
authors.initials: MA
authors.lastname: Davare
authors.affiliation: Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT 84112; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT 84112;
authors.forename: Nadeem A
authors.initials: NA
authors.lastname: Vellore
authors.affiliation: Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239; Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239;
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Wagner
authors.affiliation: Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239; Howard Hughes Medical Institute, Portland, OR 97239;
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Eide
authors.affiliation: Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239;
authors.forename: James R
authors.initials: JR
authors.lastname: Goodman
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY 10065.
authors.forename: Alexander
authors.initials: A
authors.lastname: Drilon
authors.affiliation: Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT 84112; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT 84112;
authors.forename: Michael W
authors.initials: MW
authors.lastname: Deininger
authors.affiliation: Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT 84112; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT 84112; drukerb@ohsu.edu thomas.ohare@hci.utah.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: O'Hare
authors.affiliation: Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239; Howard Hughes Medical Institute, Portland, OR 97239; drukerb@ohsu.edu thomas.ohare@hci.utah.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Druker
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D000813:Anilides / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000494:pharmacology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D000077547:Crizotinib; D055808:Drug Discovery / Q000379:methods; D019008:Drug Resistance, Neoplasm / Q000502:physiology*; D006801:Humans; D015151:Immunoblotting; D066298:In Vitro Techniques; D008958:Models, Molecular; D056004:Molecular Dynamics Simulation; D011485:Protein Binding; D011487:Protein Conformation; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000737:chemistry; D011518:Proto-Oncogene Proteins / Q000037:antagonists & inhibitors* / Q000737:chemistry; D011720:Pyrazoles; D011725:Pyridines / Q000494:pharmacology*; D011804:Quinolines; D020794:Receptor Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000737:chemistry
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C544831:GSK 1363089; D011518:Proto-Oncogene Proteins; D011720:Pyrazoles; D011725:Pyridines; D011804:Quinolines; C558660:cabozantinib; D000077547:Crizotinib; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D011505:Protein-Tyrosine Kinases; C062333:ROS1 protein, human; D020794:Receptor Protein-Tyrosine Kinases
keywords: ALK; ROS1; inhibitor; kinase; structural modelling