Don L. Gibbons, Sabrina Pricl, Hagop Kantarjian, Jorge Cortes and Alfonso Quintás-Cardama The rise and fall of gatekeeper mutations? The BCR-ABL1 T315I paradigm Cancer 118
Tyrosine kinase inhibitors (TKIs) are standard therapy for chronic myeloid leukemia (CML). However, the development of resistance breakpoint cluster region/Abelson murine leukemia 1 (BCR-ABL1) mutations impair their activity. The gatekeeper threonine-to-isoleucine mutation at codon 315 (T315I) produces complete insensitivity to all currently approved TKIs in CML. Other mutated gatekeeper residues in a variety of oncogenic kinases that drive the pathogenesis of different human cancers have proven highly resistant to TKI therapy. Advances in the structural biology of oncogenic kinases have facilitated the rational development of TKIs that are active against gatekeeper mutations, which are exemplified best by ponatinib in CML.
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