Kinase inhibitors
Protein and (lipid kinases) represent an important target class for treating human disorders, as their aberrant activity underlies a variety of pathologies, ranging from cancer, inflammatory diseases, diabetes, infectious diseases, and cardiovascular disorders.
To date more than 35 small molecule protein kinase inhibitors have been approved for human use around the world. The majority of these are for oncology indications, but a growing number are targeting immune-related conditions such as rheumatoid arthritis (tofacitinib, a Janus kinase 3 inhibitor). Two earlier inhibitors, sirolimus and everolimus (mTOR inhibitors) are used as immunosuppressants to reduce rejection of transplanted organs. Subsequently everolimus has been approved for oncology use, for the treatment of progressive, well-differentiated non-functional, neuroendocrine tumors (NET) of gastrointestinal (GI) or lung origin, in patients with unresectable, locally advanced or metastatic disease.
Approved kinase inhibitors (worldwide)
INN | Target/s | Indication/s | Year first approved |
fasudil | ROCK (ROCK1 & ROCK2) | cerebral vasospasm | 1995- China & Japan only |
sirolimus | mTOR | kidney transplants | 1999 |
imatinib | ABL, PDGFR (alpha & beta), KIT | CML, Ph+ B-ALL, CMML, HES, GIST | 2001 |
gefitinib | EGFR | NSCLC | 2003 |
erlotinib | EGFR | NSCLC, pancreatic cancer | 2004 |
sorafenib | VEGFR2, PDGFR (alpha & beta), KIT, FLT3, BRAF | RCC, HCC | 2005 |
sunitinib | VEGFR1, VEGFR2 & VEGFR3, KIT, PDGFR (alpha & beta) , RET, CSF1R, FLT3 | RCC, imatinib resistant GIST | 2006 |
dasatinib | ABL, PDGFR (alpha & beta), KIT, SRC | CML | 2007 |
lapatinib | EGFR, ERBB2 | BC | 2007 |
nilotinib | ABL, PDGFR (alpha & beta), KIT | CML | 2007 |
everolimus | mTOR | RCC, SEGA, transplantation | 2009 |
temsirolimus | mTOR | RCC | 2009 |
axitinib | VEGFR1, VEGFR2 & VEGFR3, KIT, PDGFR (alpha & beta), RET, CSF1R, FLT3 | RCC | 2011 |
ruxolitinib | JAK2 | IMF with JAK2V617F | 2011 |
RET, VEGFR1 & VEGFR2, FGFRs, EGFR | MTC | 2011 | |
vemurafenib | BRAF | m-Melanoma with BRAFV600E | 2011 |
crizotinib | MET, ALK | NSCLC with ALK translocations | 2011 |
tofacitinib | JAK3 | RA | 2012 |
pazopanib | VEGFR1, VEGFR2 & VEGFR3, PDGFR (alpha & beta), KIT | RCC | 2012 |
bosutinib | ABL | CML resistant/ intolerant to therapy | 2012 |
cabozantinib | VEGFR2, PDGFR (alpha & beta), KIT, FLT3 | MTC | 2012 |
ponatinib | ABL | T315 resistant CML | 2012 |
regorafenib | VEGFR2, Tie2 | CRC, GIST | 2012 |
afatinib | EGFR | NSCLC with EGFR activating mutations | 2013 |
dabrafenib | BRAF | m-Melanoma with BRAFV600E | 2013 |
trametinib | MEKs | m-Melanoma with BRAFV600E | 2013 |
ibrutinib | BTK | MCL | 2013 |
nintedanib | VEGFR1, VEGFR2 & VEGFR3, PDGFR (alpha & beta), FGFRs | IPF | 2014 |
idelalisib | PI3Kδ | leukemia and lymphomas | 2014 |
ceritinib | ALK | NSCLC with ALK translocations | 2014 |
alectinib | ALK | ALK-rearranged NSCLC | 2014- FDA 2015 |
cobimetinib | MEK1 & MEK2 | melanoma, BC, other solid tumours | 2015 |
lenvatinib | VEGFR1, VEGFR2 & VEGFR3 | progressive, differentiated thyroid cancer, advanced renal cell carcinoma (in combination with everolimus) | 2015 |
palbociclib | CDK4 & 6 | advanced (metastatic) BC | 2015 |
radotinib | BRC- ABL & PDGFR (alpha & beta) | CML | 2015-S Korea only |
osimertinib | mutant EGFR | T790M +ve NSCLC | 2015 |
brigatinib | ALK, EGFR | ALK-rearranged metastatic NSCLC, resistant to crizotinib | 2017 |
Disease abbreviations: BC (breast cancer), CMML (chronic myelomonocytic leukaemia), CML (chronic myeloid leukaemia), CRC (colorectal cancer), GIST (gastrointestinal cancer), HES (hypereosinophilic syndrome), IPF (idiopathic pulmonary fibrosis), MCL (Mantle cell lymphoma), MTC (medullary thyroid cancer), NSCLC (non-small cell lung cancer), Ph+ B-ALL (Philadelphia chromosome positive acute lymphoblastic leukemia), RA (rheumatoid arthritis), RCC (renal cell carcinoma), SEGA (subependymal giant cell astrocytoma)
Ten things you should know about protein kinases: IUPHAR Review 14.
This review article presents a brief history of kinase research and inhibitor development, highlighting landmarks in the drug discovery process and pointing to the limitations of their use.
A review of the progress and achievements made using kinase inhibitors to treat a wide variety of diseases, plus discussion of the future potential of these small molecules.