Direct K-Ras Inhibitors to Treat Cancers: Progress, New Insights, and Approaches to Treat Resistance

Ruth Nussinov, Hyunbum Jang

Research output: Contribution to journalReview articlepeer-review


Here we discuss approaches to K-Ras inhibition and drug resistance scenarios. A breakthrough offered a covalent drug against K-RasG12C. Subsequent innovations harnessed same-allele drug combinations, as well as cotargeting K-RasG12C with a companion drug to upstream regulators or downstream kinases. However, primary, adaptive, and acquired resistance inevitably emerge. The preexisting mutation load can explain how even exceedingly rare mutations with unobservable effects can promote drug resistance, seeding growth of insensitive cell clones, and proliferation. Statistics confirm the expectation that most resistance-related mutations are in cis, pointing to the high probability of cooperative, same-allele effects. In addition to targeted Ras inhibitors and drug combinations, bifunctional molecules and innovative tri-complex inhibitors to target Ras mutants are also under development. Since the identities and potential contributions of preexisting and evolving mutations are unknown, selecting a pharmacologic combination is taxing. Collectively, our broad review outlines considerations and provides new insights into pharmacology and resistance.

Original languageEnglish
Pages (from-to)231-253
Number of pages23
JournalAnnual Review of Pharmacology and Toxicology
StatePublished - 23 Jan 2024


FundersFunder number
U.S. Government
National Institutes of HealthHHSN261201500003I
U.S. Department of Health and Human Services
National Cancer Institute
Center for Cancer Research


    • AI
    • drug resistance
    • machine learning
    • signaling
    • targeted therapy


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