Mechanisms of resistance to small molecule kinase inhibition in the treatment of solid tumors

A growing number of tumors are characterized by simple genetic changes that activate important biochemical pathways, which are involved in their pathogenesis. These findings have led to the concept of targeted small molecule inhibitor treatment. The prototype for this type of therapy has been treatment of chronic myelogenous leukemia with imatinib mesylate (Gleevec), which targets BCR-ABL kinase. More recently, imatinib has been used to inhibit KIT in gastrointestinal (GI) stromal tumor, a mesenchymal tumor that arises in the GI tract. Furthermore, it has been possible to target EGFR in non-small-cell lung cancer with gefitinib and erlotinib. While initial results have been encouraging, resistance to small molecule kinase inhibitors is a substantial drawback. This paper focuses on what is known about mechanisms of resistance in the treatment of solid tumors by small molecule kinase inhibitors.