• Noah A Cohen, Teresa S Kim, and Ronald P DeMatteo.
• *Department of Surgery, New York University School of Medicine, New York, NY †Memorial Sloan Kettering Cancer Center, New York, NY.
• Ann. Surg. 2017 Feb 1; 265 (2): 311-319.

ObjectiveWe aimed to identify key principles of targeted therapy of protein kinases and their application to the management of solid tumors.BackgroundConcurrent advances in tumor genomic analysis and molecular inhibitor development have dramatically impacted the diagnosis and treatment of solid tumors, and common themes regarding the use of kinase inhibitors are developing.MethodsThe list of kinase inhibitors that have been approved by the US Food and Drug Administration was reviewed and articles related to the agents were searched in the PubMed database up until December 2015. We included pivotal, randomized controlled phase 2 and 3 trials, and also pertinent preclinical studies.ResultsSmall molecule inhibitors targeted against driver kinases, overactive in selected subsets of solid tumors, elicit improved response rates and survival compared with standard chemotherapy. Disease control has been proven in the metastatic and, to a limited extent, the adjuvant setting. However, tumor eradication is rare, and duration of treatment response is limited by the development of drug resistance.ConclusionsKinase inhibitors induce response in diverse types of solid tumors. Although the agents are often effective in defined molecular subsets, cure is rare and resistance is common. This broad review provides rationale for further investigation of multimodality therapy combining kinase inhibitors with additional systemic and local therapies, including surgery.

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