  Over the last two decades epidermal growth factor receptor (EGFR) kinase has
become an important target to treat non-small cell lung cancer (NSCLC).
Currently, three generations of EGFR kinase-targeted small molecule drugs have
been FDA approved. They nominally produce a response at the start of treatment
and lead to a substantial survival benefit for patients. However, long-term
treatment results in acquired drug resistance and further vulnerability to
NSCLC. Therefore, novel EGFR kinase inhibitors that specially overcome acquired
mutations are urgently needed. To this end, we carried out a comprehensive
study of different EGFR kinase mutants using a structural systems pharmacology
strategy. Our analysis shows that both wild-type and mutated structures exhibit
multiple conformational states that have not been observed in solved crystal
structures. We show that this conformational flexibility accommodates diverse
types of ligands with multiple types of binding modes. These results provide
insights for designing a new-generation of EGFR kinase inhibitor that combats
acquired drug-resistant mutations through a multi-conformation-based drug
design strategy.
