Reduced focal adhesion kinase and paxillin phosphorylation in BCR-ABL-transfected cells

BACKGROUND: BCR-ABL formation is critical to oncogenic transformation in chronic myelogenous leukemia and has been implicated as a key event leading to alterations in cytoskeletal structures and adhesion in the leukemic cells. The authors therefore investigated the effect of p210(BCR-ABL) on actin polymerization as well as on the expression and phosphorylation state of the adhesion proteins paxillin and focal adhesion kinase (FAK). METHODS: Transfection with BCR-ABL constructs abrogated the ability of NIH 3T3 fibroblasts to adhere and the cells underwent striking morphologic changes. RESULTS: Scanning electron microscopy revealed that the cells lost their elongated appearance and became rounded. This alteration was associated with significantly reduced actin polymerization. In addition, steady-state levels of paxillin and FAK protein were increased. However, while the overall level of phosphotyrosines was also increased, the amount of tyrosine phosphorylated paxillin and FAK was reduced in the BCR-ABL-transfected cells as compared to the parental cells. Culture on extracellular fibronectin matrix partially reversed the morphologic changes and resulted in a return, albeit incomplete, of filamentous actin in BCR-ABL-transfected 3T3 fibroblasts. In addition, phosphorylation of paxillin and FAK in the BCR-ABL-transfected NIH 3T3 cells was restored. CONCLUSIONS: The authors conclude that, in the current system, transfection of BCR-ABL attenuates FAK and paxillin phosphorylation and reduces actin polymerization, events accompanied by significant alterations in cellular morphology. The observation that exposure of the cells to fibronectin partially reverses all these changes suggests that the focal adhesion proteins and actin structures nevertheless remain responsive to signaling from the outside.     

非小细胞肺癌组织中FAK和pY397FAK的表达

目的:探讨粘着斑激酶(focaladh sionkinase,FAK)和磷酸化FAK(phosph FAK,pY397FAK)在非小细胞肺癌(no smallcelllungcancer,NSCLC)和正常支气管 黏膜上皮中的表达,及FAK在NSCLC发生 浸润和转移中的作用。方法:应用免疫组织 化学方法检测FAK和pY397FAK在60例 NSCLC和19例正常支气管黏膜上皮中的表 达,并与临床病理指标和Ki 67表达进行联 合分析。结果:FAK和pY397FAK在NSCL 中表达为83.3%(50/60)和55.0%(33 60),高于正常支气管黏膜上皮[57.9%(11 19)和21.1%(4/19)],差异有统计学意义 P=0.030、P=0.010。FAK和pY397FAK表 达升高与TNM分期及淋巴结转移有关,在 Ⅲ期和淋巴结转移组的阳性率高于Ⅰ+Ⅱ 期和无淋巴结转移组,差异有统计学意义, 均<0.05。FAK的强阳性表达率在低分化 组中(73.1%,19/26)显著高于高 中分化组 (47.1%,16/34),P=0.043。结论:FAK和 pY397FAK过表达在NSCLC发生和进展中发 挥重要作用。FAK和pY397FAK可能作为判 断NSCLC生物学行为的指标和治疗的新靶 点。     

Up-regulation of focal adhesion kinase in non-small cell lung cancer

Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase linked to the integrin and growth factor receptor-signalling pathways that regulates a number of the biological processes involved in neoplastic transformation, invasion and metastases, such as cell adhesion, migration and apoptosis. Its up-regulation might play a role in the tumourigenesis of invasive tumours, but its involvement in human lung cancer tissues has not yet been determined. We immunohistochemically compared FAK expression and localisation in 60 formalin-fixed and paraffin-embedded non-small cell lung cancer (NSCLC) tissues with that in the surrounding non-neoplastic tissue and in a further five microscopically normal lungs. FAK mRNA levels were quantitatively determined by real-time RT-PCR in frozen tissue specimens of all of the tumours and 21 matched non-neoplastic lung parenchymas, and protein expression in 16 homogenates of the matched neoplastic/non-neoplastic specimens was evaluated by Western blotting. The three different techniques showed that FAK is weakly expressed in non-neoplastic lung parenchyma and up-regulated in NSCLCs. Moreover, Western blotting and real-time RT-PCR indicated a statistically significant correlation between FAK up-regulation and higher disease stages (I+II versus III+IV, p=0.019 and 0.028, respectively). Our results provide evidence that FAK is up-regulated in NSCLCs, and suggest its potential involvement in lung cancer progression.     

胃泌素对胃癌细胞粘着斑激酶酪氨酸磷酸化的影响

背景与目的:胃泌素能够刺激胃癌细胞的生长和增殖,这一作用同酪氨酸激酶有关。本研究旨在阐明胃泌素对人胃癌细胞内粘着斑激酶(focaladhesion kinase,FAK)酪氨酸磷酸化的影响。方法:用人胃泌素受体(gastrinreceptor,GR)的真核表达载体pCR3.1/GR,转染人胃癌细胞株SGC7901,增强胃泌素受体表达;用胃泌素受体拮抗剂L-365260,抑制胃泌素和其受体结合;以不同浓度和作用时间的胃泌素刺激胃癌细胞,利用免疫沉淀和蛋白质印迹法检测上述情况下,FAK酪氨酸磷酸化的变化。结果:分别用0.1nmol/L、1nmol/L和10nmol/L的胃泌素作用后,转染pCR3.1/GR的SGC7901细胞内FAK酪氨酸磷酸化表达量分别为0.64±0.06、0.91±0.10和1.00±0.10,高于SGC7901细胞的0.40±0.05、0.52±0.07和0.62±0.06(P<0.01);转染pCR3.1/GR的SGC7901细胞内FAK酪氨酸磷酸化表达量分别为0.72±0.08、0.83±0.05、0.88±0.06和1.00±0.08,高于SGC7901细胞的0.59±0.05、0.65±0.07、0.58±0.03和0.47±0.10(P<0.01或P<0.05)。胃泌素受体拮抗剂L-365260使转染pCR3.1/GR的SGC7901细胞内FAK酪氨酸磷酸化表达量从1.00±0.07降至0.72±0.07(P<0.01),使SGC7901细胞内表达量由0.62±0.06降至0.45±0.05(P<0.01)。在此过程中,FAK蛋白表达量差异无统计学意义(P>0.05)。结论:FAK是胃泌素和其受体结合后发挥效应的关键下游信号分子,酪氨酸磷酸化是其活性形式。     

Gamma linolenic acid inhibits tyrosine phosphorylation of focal adhesion kinase and paxillin and tumour cell matrix interaction

Gamma linolenic acid (GLA) is an anti-cancer agent recently reported to inhibit tumour cell-matrix attachment. This study examined the effects of GLA on the adhesion of two tumour cell lines, HT115 (human colon) and MDA MB 231 (human breast), to an extracellular matrix, Matrigel. The action of GLA on focal adhesion kinase(FAK) and paxillin was also investigated. Following cell adhesion to Matrigel in control experiments, both FAK and paxillin were quickly tyrosine phosphorylated and become concentrated at focal adhesion areas. Inclusion of GLA resulted in an inhibition of the tyrosine phosphorylation of both FAK and paxillin leading to a reduced attachment of both cell types to Matrigel. FAK and paxillin were also less well distributed in the focal adhesions compared with the controls. It is concluded, therefore, that GLA inhibits tumour-matrix adhesion via the inhibition of FAK and paxillin tyrosine phosphorylation.     

Bombesin stimulates the motility of human prostate-carcinoma cells through tyrosine phosphorylation of focal adhesion kinase and of integrin-associated proteins

Bombesin-like peptides, including the mammalian homologue gastrin-releasing peptides, are highly expressed and secreted by neuroendocrine cells in prostate carcinoma (PCa) tissues and are likely to be related to the progression of this disease. In the present study, we show that bombesin enhances the migration of androgen-independent PCa cells (PC-3) in vitro, while not affecting their adhesion to extracellular matrix proteins. The bombesin-increased motility of PC-3 cells occurs through its receptor, and, as shown with inhibitors, it likely requires activation of both protein tyrosine kinases (PTKs) and protein kinases C (PKCs). Because the focal adhesion kinase pp125^FAK plays a key role in adhesion/motility and is highly expressed in advanced PCa, we examined whether in PC-3 cells bombesin signal transduction triggers the tyrosine phosphorylation of this PTK and of associated integrins and signaling proteins likely to be present in focal adhesion plaques. pp125^FAK tyrosine phosphorylation was stimulated by bombesin and mimicked by PKC activation with the tumor-promotor phorbol 12-myristate-13-acetate (PMA). Moreover, this effect of bombesin on pp125^FAK tyrosine phosphorylation requires the presence of both active PKC and cytoskeleton integrity since this signal was abolished by down-regulating PKCs induced by prolonged PMA treatment or by PKC inhibition with GF 109203X, as well as by disruption of the cytoskeleton with cytochalasin D. We also show that bombesin increases the tyrosine phosphorylation of a 95-kDa protein (pp95) which was co-immunoprecipitated with the αv and β (3 and 5) subunits, forming integrin receptors with αv in PC-3 cells. The protein pp95 is distinct from the endogenously tyrosine-phosphorylated β3 subunit. In addition, upon bombesin treatment, the β1, β3 and β5 integrin subunits co-immunoprecipitated with pp125^FAK and major phosphotyrosine (pY)-containing proteins of 125 and 68–70 kDa, likely corresponding to pp125^FAK and paxillin. Together our data suggest that, in addition to PKC activation, tyrosine phosphorylation of pp125^FAK and integrin-associated proteins may play an important role in bombesin signaling, triggering the processes of PCa cell motility and invasion. Int. J. Cancer 72:498–504, 1997. © 1997 Wiley-Liss, Inc.     

Rho-dependent and -independent tyrosine phosphorylation of focal adhesion kinase, paxillin and p130Cas mediated by Ret kinase

Glial cell line-derived neurotrophic factor (GDNF) signals through a unique receptor system that includes Ret receptor tyrosine kinase and a glycosyl-phosphatidylinositol-linked cell surface protein. In the present study, we have identified several proteins in neuroblastoma cells that are phosphorylated on tyrosine in response to GDNF. The phosphorylated proteins include focal adhesion kinase (FAK), paxillin and Crk-associated substrate, p130Cas, all of which are known to be associated with focal adhesions. Of these, paxillin and p130Cas interacted with Crk proteins in GDNF-treated neuroblastoma cells. GDNF also induced reorganization of the actin cytoskelton. Tyrosine phosphorylation of FAK, paxillin and p130Cas was inhibited by cytochalasin D or two specific inhibitors of phosphatidylinositol-3' kinase (PI-3' kinase), wortmannin and LY294002, indicating that their tyrosine phosphorylation depends on the formation of actin stress fiber and activation of PI-3' kinase. In addition, phosphorylation of FAK but not of paxillin and p130Cas was markedly impaired by the Clostridium botulinum C3 exoenzyme that specifically ADP-ribosylates and inactivates Rho. These results suggested the presence of Rho-dependent and -independent signaling pathways downstream of PI-3' kinase that mediate tyrosine phosphorylation of FAK, paxillin and p130Cas through Ret kinase.     

Cortactin及FAKPY397在非小细胞肺癌中的表达及关系

目的:探讨皮层肌动蛋白(cortactin)及磷酸化黏着斑激酶(focal adhesion kinase PY397,FAKPY397)在非小细胞肺癌(non-small cell lung cancer,NSCLC)组织中的表达情况及与临床病理因素之间的关系。方法:采用免疫组织化学方法检测114例NSCLC及相应癌旁正常肺组织中cortactin及FAKPY397的表达情况。结果:Cortactin在正常肺组织中表达阳性率为19.3%(22/114),显著低于其在NSCLC组织中的阳性率为57.9%(66/114,P<0.001)。Ⅲ、Ⅳ期组中cortactin表达阳性率为78.8%(26/33)显著高于Ⅰ、Ⅱ期组的49.4%(40/81,P=0.004),有淋巴结转移组中cortactin阳性率为74.0%(37/50)显著高于无淋巴结转移组的45.3%(29/64,P=0.002)。FAKPY397在正常肺组织中表达阳性率为25.4%(29/114),显著低于其在NSCLC组织中的阳性率为52.6%(60/114)。Ⅲ、Ⅳ期组中FAKPY397的表达阳性率为69.7%(23/33)显著高于Ⅰ、Ⅱ期组中的阳性率为45.7%(37/81,P=0.020),有淋巴结转移组中FAKPY397阳性率为64.0%(32/50)显著高于无淋巴结转移组的43.8%(28/64,P=0.032)。Speaman相关性分析表明在NSCLC中,cortactin的表达与FAKPY397的表达呈正相关(r=0.436,P<0.01)。结论:NSCLC中cortactin的表达与FAKPY397的表达呈正相关,二者协同表达可能是促进NSCLC进展的因素之一。     

Hepatocyte growth factor induces tyrosine phosphorylation of focal adhesion kinase (FAK) and paxillin and enhances cell-matrix interactions

This study examined the effects of hepatocyte growth factor/scatter factor (HGF/SF) on the adhesion of HT115 (human colon) and MDA MB 231 (human breast) tumour cells to an extracellular matrix, Matrigel, together with the tyrosine phosphorylation of focal adhesion kinase (FAK) and paxillin. Treatment of cells with HGF increased cell adhesion to matrix. Following adhesion to Matrigel, FAK and paxillin were quickly phosphorylated and located to the focal adhesion area. HGF/SF increased both tyrosine phosphorylation of FAK and paxillin and also increased formation of focal adhesion. HGF also induced an increased spreading on matrix. It is concluded therefore that HGF/SF stimulated FAK and paxillin phosphorylation resulting in an increased tumour-matrix adhesion.     

Yes-mediated phosphorylation of focal adhesion kinase at tyrosine 861 increases metastatic potential of prostate cancer cells

To study the role of FAK signaling complexes in promoting metastatic properties of prostate cancer (PCa) cells, we selected stable, highly migratory variants, termed PC3 Mig-3 and DU145 Mig-3, from two well-characterized PCa cell lines, PC3 and DU145. These variants were not only increased migration and invasion in vitro, but were also more metastatic to lymph nodes following intraprostatic injection into nude mice. Both PC3 Mig-3 and DU145 Mig-3 were specifically increased in phosphorylation of FAK Y861. We therefore examined potential alterations in Src family kinases responsible for FAK phosphorylation and determined only Yes expression was increased. Overexpression of Yes in PC3 parental cells and src−/−fyn−/−yes−/− fibroblasts selectively increased FAK Y861 phosphorylation, and increased migration. Knockdown of Yes in PC3 Mig-3 cells decreased migration and decreased lymph node metastasis following orthotopic implantation of into nude mice. In human specimens, Yes expression was increased in lymph node metastases relative to paired primary tumors from the same patient, and increased pFAK Y861 expression in lymph node metastases correlated with poor prognosis. These results demonstrate a unique role for Yes in phosphorylation of FAK and in promoting PCa metastasis. Therefore, phosphorylated FAK Y861 and increased Yes expression may be predictive markers for PCa metastasis.     

Paxillin null embryonic stem cells are impaired in cell spreading and tyrosine phosphorylation of focal adhesion kinase.

Paxillin is a focal-adhesion associated protein implicated in the regulation of integrin signaling and organization of the actin cytoskeleton. Paxillin associates with numerous signaling molecules including adaptor molecules (p130Cas, CRK), kinases (FAK, Pyk2, PAK and SRC), tyrosine phosphatases (PTP-PEST), ARF-GAP proteins (p95pkl, PAG3) and papillomavirus E6 oncoproteins. Although paxillin is tyrosine phosphorylated in cellular processes such as cell attachment and spreading, little direct evidence is available about paxillin's role in these events. Targeted gene disruption was used to generate paxillin null mouse embryonic stem (ES) cells and paxillin null differentiated cells. Paxillin null ES cells exhibit delayed spreading on integrin binding substrates fibronectin and laminin, and there is reduced tyrosine phosphorylation of Focal Adhesion Kinase (FAK). Both of these phenotypes are recovered in paxillin knockout cells upon exogenous re-expression of paxillin. The individual LD motifs of paxillin that are binding sites for FAK, vinculin and ARF-GAP proteins, as well as tyrosine residues that when phosphorylated create binding sites for CRK family members, are dispensable for FAK phosphorylation and early cell spreading. These results demonstrate that paxillin contributes to attachment-dependent tyrosine phosphorylation of FAK and early cell spreading in ES cells.     

Inhibition of proliferation of human small cell lung cancer cells expressing an autocrine system for gastrin releasing peptide by antisense oligodeoxynucleotides to gastrin releasing peptide receptor

The objectives of this study were to investigate the effect of antisense (AS) oligodeoxynucleotides (ODNs) directed against gastrin releasing peptide (GRP) receptor mRNA on proliferation of human small cell lung cancer (SCLC) NCI-H345 cells which express the autocrine system for GRP. The methods used were to expose human SCLC cell lines to antisense ODNs or sense ODNs and to measure their proliferation by spectrophotometric assay or viable cell counts. Our results demonstrated that the single or combined AS ODNs against GRP receptor inhibited proliferation of human SCLC NCI-H345 cells significantly by 37% (P<0.01), but did not inhibit proliferation of either human bronchial epithelial BEAS 2B cells or human SCLC NCI-N417 cells, neither of which express the GRP autocrine system. The sense controls did not significantly inhibit proliferation compared with no treatment controls. Specificity was also demonstrated by the observation that cells exposed to AS ODNs had a decrease in GRP receptor expression as measured by specific binding of 34% (P<0.01), and when all three AS ODNs were used, binding was decreased by 60% (P<0.03). Furthermore, AS ODNs decreased by 75% the maximum percentage of cells responding to GRP in an intracellular calcium release assay. Our conclusions are that antisense ODNs directed against a GRP receptor which is involved in an autocrine loop in human SCLC cells inhibited proliferation of these cells by their impact on reducing GRP receptor expression. Further development of means of increasing AS ODN specificity and effectiveness in human SCLC cell is warranted.     

Up-regulation of proline-rich tyrosine kinase 2 in non-small cell lung cancer

Proline-rich tyrosine kinase 2 (PYK2) is a non-receptor tyrosine kinase, plays different roles in intracellular signaling pathways, that regulates a number of biological processes, such as cell proliferation, differentiation, adhesion and migration, which have been shown to correlate with tumor development and aggression. However, the involvement of PYK2 in human non-small cell lung cancer (NSCLC) has not yet been determined. In the present study, 90 patients with NSCLC (represented by adenocarcinoma and squamous cell carcinoma) were included retrospectively. NSCLC tissues were detected for the expression of PYK2 by immunohistochemistry. Correlation between the expression of PYK2 with the clinicopathological characteristics was analyzed. There were 64% (58 out of 90) of NSCLC patients with higher level of PYK2. Higher expression of PYK2 was significantly correlated with lymph node metastasis (node positive versus node negative, p=0.007). Patients with higher expression of PYK2 had advanced stage of NSCLCs (I+II versus III+IV, p=0.012). Protein level of PYK2 was also examined in 30 of these tumorous samples and matched non-tumorous counterparts by western blotting. PYK2 was apparently up-regulated in NSCLC tissues (tumor versus non-tumor, p=0.000). In the cell studies, extensive expression and activation of PYK2 were both found in higher metastatic BE1 cells. The activity of ERK1/2 in BE1 cells appeared extremely high as well. In conclusion, our results demonstrated that PYK2 is up-regulated in NSCLCs, and the higher expression and activation of PYK2 may play a role in modulating the activity of ERK1/2, and lead to the progression of NSCLC.     

Epidermal growth factor receptor tyrosine kinase inhibitors for non-small cell lung cancer

First-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), including gefitinib and erlotinib, have proven to be highly effective agents for advanced non-small cell lung cancer (NSCLC) in patients harboring an activating EGFR mutation such as the exon 19 deletion mutation and L858R. Although those reversible small molecular targeted agents provide a significant response and survival benefit, all responders eventually acquire resistance. Second-generation EGFR-targeting agents, such as irreversible EGFR/HER2 tyrosine kinase inhibitors and pan-HER TKIs, may improve survival further and be useful for patients who acquired resistance to first-generation EGFR-TKIs. This review discusses novel therapeutic strategies for EGFR-mutated advanced NSCLC using first- and second-generation EGFR-TKIs.     

Second-generation epidermal growth factor receptor tyrosine kinase inhibitors in non-small cell lung cancer

Inhibiting epidermal growth factor receptor (EGFR) signaling has proven to be an effective strategy for treating non-small cell lung cancer (NSCLC) patients and the first generation of agents developed for this purpose, gefitinib and erlotinib, stimulated a unique escalation in both biologic and clinical research within the field. Second-generation EGFR-targeted agents that aim to further improve patient outcomes are now in preclinical and clinical trials. This review discusses four promising agents that are currently being studied in NSCLC: EKB-569, HKI-272, CI-1033, and ZD6474.     

Tenascin-C promotes microvascular cell migration and phosphorylation of focal adhesion kinase

Enhanced expression of tenascin-C (TN-C) at the invasive edges of glioblastoma multiforme in close association with vascular sprouts, suggests a role for TN-C in microvascular cell migration. To test this hypothesis, we studied the migration of endothelial cells in vitro. In an aggregate migration assay, bovine retinal endothelial cells (BRECs) and human umbilical vein endothelial cells spread and migrated similarly on TN-C or fibronectin (FN). In contrast, U251 MG glioma cells migrated less on TN-C than on FN. Morphological features of U251 MG glioma cells on TN-C included poor cell spreading and short processes. In contrast, on FN, U251 MG glioma cells spread and exhibited long radial processes. Using a transmembrane migration assay, we observed that BREC adhesion was similar on TN-C or FN, whereas U251 MG glioma cells adhered better to FN than to TN-C. In addition, BRECs migrated more across the membrane toward regions coated with TN-C than FN, and conversely, U251 MG glioma cells migrated more toward FN than TN-C. Migration of endothelial and glioma cells toward TN-C or FN occurred in a dose-dependent manner and was strongly dependent on cell adhesion. In this assay, ultrastructural study revealed the migrating phenotype of the endothelial cells through the micropores of the membrane and their spread morphology on TN-C. Moreover, in situ hybridization revealed specific expression of TN-C in migrating microvascular cells in a cerebral microvascular ring assay. Finally in a phosphorylation assay, TN-C enhanced focal adhesion kinase phosphorylation of BRECs, but not of U251 MG glioma cells, and FN enhanced focal adhesion kinase phosphorylation of both BRECs and U251 MG cells. The expression of TN-C by migrating endothelial cells and the promotion of endothelial cell adhesion and migration by TN-C suggest a potential role for TN-C in pathological angiogenesis.     

Hyaluronate activates tyrosine phosphorylation of cellular proteins including focal adhesion kinase via CD44 in human glioma cells

To search for the signaling pathway of glioma cells relevant to its aggressive behavior, we examined hyaluronate-CD44 signaling. CD44, a hyaluronate receptor, is known to be highly expressed in glioma and its expression showed good correlation with invasiveness of the tumor. Treatment of glioma cells with hyaluronate activated rapid and transient tyrosine phosphorylation of several proteins including p125(FAK), while neuroblastoma cells that express no detectable CD44 had no response to the treatment. This hyaluronate-dependent tyrosine phosphorylation was blocked by anti-CD44 antibody, suggesting its direct mediation by CD44. Moreover, we found that hyaluronate-treatment activated mitogen activated protein (MAP) kinase. These results strongly suggest that hyaluronate-CD44 signaling may play a role in tumor invasion and proliferation by activation of p125(FAK) and MAP kinase in human glioma cells.     

Multitargeted receptor tyrosine kinase inhibition: an antiangiogenic strategy in non-small cell lung cancer

In the United States, the leading cause of cancer-related deaths is lung cancer, of which more than 85% of cases are categorized as non-small cell lung cancer. The process of angiogenesis, which results in the formation of vasculature, is a complex and coordinated process that is required for cancer growth and metastasis. Pathways that promote angiogenesis have been targeted as a therapeutic approach in multiple types of cancer, including non-small cell lung cancer. Of these, the vascular endothelial growth factor pathway has been the most well studied, but more recently, the platelet-derived growth factor and fibroblast growth factor pathways have been identified as regulators of angiogenesis and potential mediators of resistance to vascular endothelial growth factor inhibition. Bevacizumab, a monoclonal antibody that binds to vascular endothelial growth factor, is currently the only antiangiogenic drug approved for the treatment of non-small cell lung cancer; however, several tyrosine kinase inhibitors that target vascular endothelial growth factor receptors as well as platelet-derived growth factor receptors and/or fibroblast growth factor receptors are being developed. This article reviews the role of the fibroblast growth factor and platelet-derived growth factor pathways in angiogenesis and provides a summary of dual (e.g., sorafenib, sunitinib) and triple (e.g., BIBF 1120, pazopanib) antiangiogenic tyrosine kinase inhibitors currently in development for the treatment of non-small cell lung cancer.