Treatment with G12C inhibitors can lead to acquired resistance • In a study on patients under G12C inhibitor treatment for lung cancer (NCSCLC), colorectal cancer (CRC) and appendix cancer (AC) that acquired resistance, numerous acquired mutations were detected (figure on right, and citation in lower right) • Mutations at the G12 codon other than “C” would lead to a failure of G12C inhibitors. Concurrent mutations in switch II binding pocket (Q, R, H, Y) also affect sotorasib, adagrasib • Supports need to develop pan-KRAS inhibitors, and drugs with alternative modes of binding for combo therapy https://www.nejm.org/doi/10.1056/N EJMoa2105281 © Elix, Inc.