Overcoming C797S mutation: The challenges and prospects of the fourth-generation EGFR-TKIs

The third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have accomplished impressive clinical achievements in the treatment of non-small-cell lung cancer (NSCLC). Nonetheless, the acquired drug resistance largely limits their clinical use. The tertiary C797S mutation in the kinase domain of EGFR is one of the major mechanisms responsible for the drug resistance. Therefore, much attention has been focused on the development of the fourth-generation EGFR-TKIs to target triple mutant epidermal growth factor receptor (EGFR) with C797S mutation. In this review, we outline the panorama of the fourth-generation EGFR-TKIs reported up to now with the attention paid on the design strategy, binding mode and antitumor activity of these EGFR-TKIs. We also discuss the challenges and prospects of the fourth-generation EGFR-TKIs.