Drug Information

Drug (ID: DG00617) and It's Reported Resistant Information
Name
Cabozantinib
Synonyms
Cabozantinib; 849217-68-1; Cometriq; XL184; XL-184; BMS-907351; XL 184; BMS 907351; Cabozantinib (XL184, BMS-907351); UNII-1C39JW444G; CHEBI:72317; XL-184 free base; BMS907351; 1C39JW444G; MFCD20926324; N'-[4-[(6,7-DIMETHOXY-4-QUINOLINYL)OXY]PHENYL]-N-(4-FLUOROPHENYL)-1,1-CYCLOPROPANEDICARBOXAMIDE; Cabometyx (TN); Cometriq (TN); 1-N-[4-(6,7-dimethoxyquinolin-4-yl)oxyphenyl]-1-N'-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide; C28H24FN3O5; N-{4-[(6,7-dimethoxyquinolin-4-yl)oxy]phenyl}-N'-(4-fluorophenyl)cyclopropane-1,1- dicarboxamide; N-{4-[(6,7-dimethoxyquinolin-4-yl)oxy]phenyl}-N'-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide; XL184 cpd; Cabozantinib [USAN:INN]; Carbozantinib; XL184 free base; Cabozantinib (USAN); Cabozantinib (free base); SCHEMBL360795; GTPL5887; Cabozantinib (BMS-907351); CHEMBL2105717; DTXSID10233968; EX-A075; QCR-122; SYN1138; XL184 free base - Cabozantinib; BCPP000308; BMS-907351 FREE BASE; HMS3654G06; XL-184 free base (Cabozantinib); AOB87755; BCP02591; 849217-68-1 (free base); BDBM50021574; NSC761068; NSC800066; s1119; ZINC70466416; AKOS025142112; BCP9000470; CCG-264678; CS-0278; DB08875; NSC-761068; NSC-800066; SB20062; XL-184 (Cabozantinib,BMS907351); XL-184,Cabozantinib, BMS-907351; NCGC00263164-01; NCGC00263164-14; NCGC00263164-17; 1,1-Cyclopropanedicarboxamide, N'-[4-[(6,7-dimethoxy-4-quinolinyl)oxy]phenyl]-N-(4-fluorophenyl)-; 1,1-Cyclopropanedicarboxamide,N-[4-[(6,7-dimethoxy-4-quinolinyl)oxy]phenyl]-N'-(4-fluorophenyl)-; AC-25082; AS-16277; HY-13016; n-(4-((6,7-dimethoxy-4-quinolinyl)oxy)phenyl)-n'-(4-fluorophenyl)-1,1-cyclopropanedicarboxamide; SY097158; DB-023624; FT-0664184; SW218093-3; X7477; D10062; AB01565831_02; Q795057; SR-01000941569; J-523016; SR-01000941569-1; BRD-K51544265-001-01-8; 1,1-Cyclopropanedicarboxamide, N'-(4-((6,7-dimethoxy-4-quinolinyl)oxy]phenyl]-N-(4- fluorophenyl)-; cyclopropane-1,1-dicarboxylic acid [4-(6,7-dimethoxy-quinoline-4-yloxy)-phenyl]-amide(4-fluoro-phenyl)-amide; cyclopropane-1,1-dicarboxylic acid[4-(6,7-dimethoxy-quinoline-4-yloxy)-phenyl]-amide (4-fluoro-phenyl)-amide; N-(4-{[6,7-bis(methyloxy)quinolin-4-yl]oxy}phenyl)-N'-(4 fluorophenyl)cyclopropane-1,1-dicarboxamide; N-(4-{[6,7-bis(methyloxy)quinolin-4-yl]oxy}phenyl)-N'-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide; N-[4-[(6,7-Dimethoxy-4-quinolinyl)oxy]phenyl]-N-(4-fluorophenyl)-1,1-cyclopropanedicarboxamide; N-[4-[(6,7-Dimethoxyquinolin-4-yl)oxy]phenyl]-N inverted exclamation mark -(4-fluorophenyl)cyclopropane-1,1-dicarboxamide
    Click to Show/Hide
Indication
In total 3 Indication(s)
Ovarian cancer [ICD-11: 2C73]
Approved
[1]
Thyroid cancer [ICD-11: 2D10]
Approved
[1]
Thyroid cancer [ICD-11: 2D10]
Approved
[1]
Structure
Drug Resistance Disease(s)
Disease(s) with Clinically Reported Resistance for This Drug (4 diseases)
Kidney cancer [ICD-11: 2C90]
[2]
Liver cancer [ICD-11: 2C12]
[3]
Lung cancer [ICD-11: 2C25]
[4]
Multiple endocrine neoplasia [ICD-11: 2F7A]
[1]
Disease(s) with Resistance Information Discovered by Cell Line Test for This Drug (2 diseases)
Liver cancer [ICD-11: 2C12]
[3]
Solid tumour/cancer [ICD-11: 2A00-2F9Z]
[5]
Target Proto-oncogene c-Met (MET) MET_HUMAN [2]
Vascular endothelial growth factor receptor 2 (KDR) VGFR2_HUMAN [2]
Click to Show/Hide the Molecular Information and External Link(s) of This Drug
Formula
C28H24FN3O5
IsoSMILES
COC1=CC2=C(C=CN=C2C=C1OC)OC3=CC=C(C=C3)NC(=O)C4(CC4)C(=O)NC5=CC=C(C=C5)F
InChI
1S/C28H24FN3O5/c1-35-24-15-21-22(16-25(24)36-2)30-14-11-23(21)37-20-9-7-19(8-10-20)32-27(34)28(12-13-28)26(33)31-18-5-3-17(29)4-6-18/h3-11,14-16H,12-13H2,1-2H3,(H,31,33)(H,32,34)
InChIKey
ONIQOQHATWINJY-UHFFFAOYSA-N
PubChem CID
25102847
ChEBI ID
CHEBI:72317
TTD Drug ID
D0IQ6P
INTEDE ID
DR0254
DrugBank ID
DB08875
Type(s) of Resistant Mechanism of This Drug due to Structure Alteration
  EADR: Epigenetic Alteration of DNA, RNA or Protein
  UAPP: Unusual Activation of Pro-survival Pathway
Drug Resistance Data Categorized by Their Corresponding Diseases
ICD-02: Benign/in-situ/malignant neoplasm
Click to Show/Hide the Resistance Disease of This Class
Solid tumour/cancer [ICD-11: 2A00-2F9Z]
Click to Show/Hide
Drug Sensitivity Data Categorized by Their Corresponding Mechanisms
  Epigenetic Alteration of DNA, RNA or Protein (EADR) Click to Show/Hide
Key Molecule: Hepatocyte growth factor receptor (MET) [6]
Sensitive Disease Solid tumour/cancer [ICD-11: 2A00-2F9Z]
 Disease Info 
Molecule Alteration Missense mutation
p.D1228V (c.3683A>T)
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.71  Å
PDB: 5HNI
Mutant Type Structure Method: X-ray diffraction Resolution: 1.67  Å
PDB: 6SDC
   Download The Information of Sequence       Download The Structure File   
RMSD: 1.85
TM score: 0.88477
Amino acid change:
D1228V
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
-
G
-
D
1040
|
-
S
-
D
-
I
-
S
-
S
-
P
-
L
-
L
-
Q
N
N
1050
|
T
T
V
V
H
H
I
I
D
D
L
L
S
S
A
A
L
L
N
N
1060
|
P
P
E
E
L
L
V
V
Q
Q
A
A
V
V
Q
Q
H
H
V
V
1070
|
V
V
I
I
G
G
P
P
S
S
S
S
L
L
I
I
V
V
H
H
1080
|
F
F
N
N
E
E
V
V
I
I
G
G
R
R
G
G
H
H
F
F
1090
|
G
G
C
C
V
V
Y
Y
H
H
G
G
T
T
L
L
L
L
D
D
1100
|
N
N
D
D
G
G
K
K
K
K
I
I
H
H
C
C
A
A
V
V
1110
|
K
K
S
S
L
L
N
N
R
R
I
I
T
T
D
D
I
I
G
G
1120
|
E
E
V
V
S
S
Q
Q
F
F
L
L
T
T
E
E
G
G
I
I
1130
|
I
I
M
M
K
K
D
D
F
F
S
S
H
H
P
P
N
N
V
V
1140
|
L
L
S
S
L
L
L
L
G
G
I
I
C
C
L
L
R
R
S
S
1150
|
E
E
G
G
S
S
P
P
L
L
V
V
V
V
L
L
P
P
Y
Y
1160
|
M
M
K
K
H
H
G
G
D
D
L
L
R
R
N
N
F
F
I
I
1170
|
R
R
N
N
E
E
T
T
H
H
N
N
P
P
T
T
V
V
K
K
1180
|
D
D
L
L
I
I
G
G
F
F
G
G
L
L
Q
Q
V
V
A
A
1190
|
K
K
G
G
M
M
K
K
F
Y
L
L
A
A
S
S
K
K
K
K
1200
|
F
F
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
1210
|
C
C
M
M
L
L
D
D
E
E
K
K
F
F
T
T
V
V
K
K
1220
|
V
V
A
A
D
D
F
F
G
G
L
L
A
A
R
R
D
V
M
M
1230
|
Y
Y
D
D
K
K
E
E
F
Y
D
Y
S
S
V
V
H
H
N
N
1240
|
K
K
T
T
G
G
A
A
K
K
L
L
P
P
V
V
K
K
W
W
1250
|
M
M
A
A
L
L
E
E
S
S
L
L
Q
Q
T
T
Q
Q
K
K
1260
|
F
F
T
T
T
T
K
K
S
S
D
D
V
V
W
W
S
S
F
F
1270
|
G
G
V
V
L
L
L
L
W
W
E
E
L
L
M
M
T
T
R
R
1280
|
G
G
A
A
P
P
P
P
Y
Y
P
P
D
D
V
V
N
N
T
T
1290
|
F
F
D
D
I
I
T
T
V
V
Y
Y
L
L
L
L
Q
Q
G
G
1300
|
R
R
R
R
L
L
L
L
Q
Q
P
P
E
E
Y
Y
C
C
P
P
1310
|
D
D
P
P
L
L
Y
Y
E
E
V
V
M
M
L
L
K
K
C
C
1320
|
W
W
H
H
P
P
K
K
A
A
E
E
M
M
R
R
P
P
S
S
1330
|
F
F
S
S
E
E
L
L
V
V
S
S
R
R
I
I
S
S
A
A
1340
|
I
I
F
F
S
S
T
T
F
F
I
I
G
G
E
-
H
-
Y
-
1350
|
V
-
H
-
V
-
N
-
A
-
T
-
Y
-
V
-
N
-
V
-
1360
|
K
-
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model PC9 cells Lung Homo sapiens (Human) CVCL_B260
293T cells Breast Homo sapiens (Human) CVCL_0063
Ba/F3 cells Colon Homo sapiens (Human) CVCL_0161
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 MTS assay
Mechanism Description There is a patient with metastatic NSCLC with MET-mediated resistance to EGFR TKI who responded to treatment with a type I MET inhibitor, savolitinib, given in combination with a third-generation EGFR inhibitor, osimertinib. The patient then developed acquired resistance mediated by a novel MET kinase domain mutation.
Key Molecule: Hepatocyte growth factor receptor (MET) [7]
Sensitive Disease Solid tumour/cancer [ICD-11: 2A00-2F9Z]
 Disease Info 
Molecule Alteration Missense mutation
p.Y1230H (c.3688T>C)
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.71  Å
PDB: 5HNI
Mutant Type Structure Method: X-ray diffraction Resolution: 1.97  Å
PDB: 5HLW
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.65
TM score: 0.96625
Amino acid change:
Y1230H
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
N
-
1050
|
T
-
V
-
H
-
I
-
D
-
L
-
S
-
A
A
L
L
N
N
1060
|
P
P
E
E
L
L
V
V
Q
Q
A
A
V
V
Q
Q
H
H
V
V
1070
|
V
V
I
I
G
G
P
P
S
S
S
S
L
L
I
I
V
V
H
H
1080
|
F
F
N
N
E
E
V
V
I
I
G
G
R
R
G
G
H
H
F
F
1090
|
G
G
C
C
V
V
Y
Y
H
H
G
G
T
T
L
L
L
L
D
D
1100
|
N
N
D
D
G
G
K
K
K
K
I
I
H
H
C
C
A
A
V
V
1110
|
K
K
S
S
L
L
N
N
R
R
I
I
T
T
D
D
I
I
G
G
1120
|
E
E
V
V
S
S
Q
Q
F
F
L
L
T
T
E
E
G
G
I
I
1130
|
I
I
M
M
K
K
D
D
F
F
S
S
H
H
P
P
N
N
V
V
1140
|
L
L
S
S
L
L
L
L
G
G
I
I
C
C
L
L
R
R
S
S
1150
|
E
E
G
G
S
S
P
P
L
L
V
V
V
V
L
L
P
P
Y
Y
1160
|
M
M
K
K
H
H
G
G
D
D
L
L
R
R
N
N
F
F
I
I
1170
|
R
R
N
N
E
E
T
T
H
H
N
N
P
P
T
T
V
V
K
K
1180
|
D
D
L
L
I
I
G
G
F
F
G
G
L
L
Q
Q
V
V
A
A
1190
|
K
K
G
G
M
M
K
K
F
Y
L
L
A
A
S
S
K
K
K
K
1200
|
F
F
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
1210
|
C
C
M
M
L
L
D
D
E
E
K
K
F
F
T
T
V
V
K
K
1220
|
V
V
A
A
D
D
F
F
G
G
L
L
A
A
R
R
D
D
M
M
1230
|
Y
H
D
D
K
K
E
E
F
Y
D
Y
S
S
V
V
H
H
N
N
1240
|
K
K
T
T
G
G
A
A
K
K
L
L
P
P
V
V
K
K
W
W
1250
|
M
M
A
A
L
L
E
E
S
S
L
L
Q
Q
T
T
Q
Q
K
K
1260
|
F
F
T
T
T
T
K
K
S
S
D
D
V
V
W
W
S
S
F
F
1270
|
G
G
V
V
L
L
L
L
W
W
E
E
L
L
M
M
T
T
R
R
1280
|
G
G
A
A
P
P
P
P
Y
Y
P
P
D
D
V
V
N
N
T
T
1290
|
F
F
D
D
I
I
T
T
V
V
Y
Y
L
L
L
L
Q
Q
G
G
1300
|
R
R
R
R
L
L
L
L
Q
Q
P
P
E
E
Y
Y
C
C
P
P
1310
|
D
D
P
P
L
L
Y
Y
E
E
V
V
M
M
L
L
K
K
C
C
1320
|
W
W
H
H
P
P
K
K
A
A
E
E
M
M
R
R
P
P
S
S
1330
|
F
F
S
S
E
E
L
L
V
V
S
S
R
R
I
I
S
S
A
A
1340
|
I
I
F
F
S
S
T
T
F
F
I
I
G
G
E
E
H
H
Y
Y
1350
|
V
V
H
H
V
V
N
N
A
A
T
T
Y
-
V
-
N
-
V
-
1360
|
K
-
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model NIH3T3 cells Embryo Homo sapiens (Human) CVCL_0594
In Vivo Model Athymic female mouse PDX model Mus musculus
Experiment for
Drug Resistance		 MTS assay
Mechanism Description MET mutations Y1248H and D1246N are resistance mechanisms for type I MET-TKIs. NIH3T3 cells expressing either mutation showed resistance to both INC280 and crizotinib but not cabozantinib, indicating the potential of sequential use of MET inhibitors may lead to a more durable response.
Lung cancer [ICD-11: 2C25]
Click to Show/Hide
Drug Sensitivity Data Categorized by Their Corresponding Mechanisms
  Epigenetic Alteration of DNA, RNA or Protein (EADR) Click to Show/Hide
Key Molecule: Hepatocyte growth factor receptor (MET) [6]
Sensitive Disease Lung adenocarcinoma [ICD-11: 2C25.0]
 Disease Info 
Molecule Alteration Missense mutation
p.D1228V (c.3683A>T)
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.71  Å
PDB: 5HNI
Mutant Type Structure Method: X-ray diffraction Resolution: 1.67  Å
PDB: 6SDC
   Download The Information of Sequence       Download The Structure File   
RMSD: 1.85
TM score: 0.88477
Amino acid change:
D1228V
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
-
G
-
D
1040
|
-
S
-
D
-
I
-
S
-
S
-
P
-
L
-
L
-
Q
N
N
1050
|
T
T
V
V
H
H
I
I
D
D
L
L
S
S
A
A
L
L
N
N
1060
|
P
P
E
E
L
L
V
V
Q
Q
A
A
V
V
Q
Q
H
H
V
V
1070
|
V
V
I
I
G
G
P
P
S
S
S
S
L
L
I
I
V
V
H
H
1080
|
F
F
N
N
E
E
V
V
I
I
G
G
R
R
G
G
H
H
F
F
1090
|
G
G
C
C
V
V
Y
Y
H
H
G
G
T
T
L
L
L
L
D
D
1100
|
N
N
D
D
G
G
K
K
K
K
I
I
H
H
C
C
A
A
V
V
1110
|
K
K
S
S
L
L
N
N
R
R
I
I
T
T
D
D
I
I
G
G
1120
|
E
E
V
V
S
S
Q
Q
F
F
L
L
T
T
E
E
G
G
I
I
1130
|
I
I
M
M
K
K
D
D
F
F
S
S
H
H
P
P
N
N
V
V
1140
|
L
L
S
S
L
L
L
L
G
G
I
I
C
C
L
L
R
R
S
S
1150
|
E
E
G
G
S
S
P
P
L
L
V
V
V
V
L
L
P
P
Y
Y
1160
|
M
M
K
K
H
H
G
G
D
D
L
L
R
R
N
N
F
F
I
I
1170
|
R
R
N
N
E
E
T
T
H
H
N
N
P
P
T
T
V
V
K
K
1180
|
D
D
L
L
I
I
G
G
F
F
G
G
L
L
Q
Q
V
V
A
A
1190
|
K
K
G
G
M
M
K
K
F
Y
L
L
A
A
S
S
K
K
K
K
1200
|
F
F
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
1210
|
C
C
M
M
L
L
D
D
E
E
K
K
F
F
T
T
V
V
K
K
1220
|
V
V
A
A
D
D
F
F
G
G
L
L
A
A
R
R
D
V
M
M
1230
|
Y
Y
D
D
K
K
E
E
F
Y
D
Y
S
S
V
V
H
H
N
N
1240
|
K
K
T
T
G
G
A
A
K
K
L
L
P
P
V
V
K
K
W
W
1250
|
M
M
A
A
L
L
E
E
S
S
L
L
Q
Q
T
T
Q
Q
K
K
1260
|
F
F
T
T
T
T
K
K
S
S
D
D
V
V
W
W
S
S
F
F
1270
|
G
G
V
V
L
L
L
L
W
W
E
E
L
L
M
M
T
T
R
R
1280
|
G
G
A
A
P
P
P
P
Y
Y
P
P
D
D
V
V
N
N
T
T
1290
|
F
F
D
D
I
I
T
T
V
V
Y
Y
L
L
L
L
Q
Q
G
G
1300
|
R
R
R
R
L
L
L
L
Q
Q
P
P
E
E
Y
Y
C
C
P
P
1310
|
D
D
P
P
L
L
Y
Y
E
E
V
V
M
M
L
L
K
K
C
C
1320
|
W
W
H
H
P
P
K
K
A
A
E
E
M
M
R
R
P
P
S
S
1330
|
F
F
S
S
E
E
L
L
V
V
S
S
R
R
I
I
S
S
A
A
1340
|
I
I
F
F
S
S
T
T
F
F
I
I
G
G
E
-
H
-
Y
-
1350
|
V
-
H
-
V
-
N
-
A
-
T
-
Y
-
V
-
N
-
V
-
1360
|
K
-
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model PC9 cells Lung Homo sapiens (Human) CVCL_B260
293T cells Breast Homo sapiens (Human) CVCL_0063
Ba/F3 cells Colon Homo sapiens (Human) CVCL_0161
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 MTS assay
Mechanism Description There is a patient with metastatic NSCLC with MET-mediated resistance to EGFR TKI who responded to treatment with a type I MET inhibitor, savolitinib, given in combination with a third-generation EGFR inhibitor, osimertinib. The patient then developed acquired resistance mediated by a novel MET kinase domain mutation.
Thyroid cancer [ICD-11: 2D10]
Click to Show/Hide
Drug Sensitivity Data Categorized by Their Corresponding Mechanisms
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Proto-oncogene tyrosine-protein kinase receptor Ret (RET) [8]
Sensitive Disease Thyroid gland cancer [ICD-11: 2D10.0]
 Disease Info 
Molecule Alteration Missense mutation
p.M918T (c.2753T>C)
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.64  Å
PDB: 7DUA
Mutant Type Structure Method: X-ray diffraction Resolution: 2.12  Å
PDB: 4CKI
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.93
TM score: 0.95555
Amino acid change:
M918T
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
700
|
G
G
P
P
L
L
S
S
L
L
S
S
V
V
D
D
A
A
F
F
710
|
K
K
I
I
L
L
E
E
D
D
P
P
K
K
W
W
E
E
F
F
720
|
P
P
R
R
K
K
N
N
L
L
V
V
L
L
G
G
K
K
T
T
730
|
L
L
G
G
E
E
G
G
E
E
F
F
G
G
K
K
V
V
V
V
740
|
K
K
A
A
T
T
A
A
F
F
H
H
L
L
K
K
G
G
R
R
750
|
A
A
G
G
Y
Y
T
T
T
T
V
V
A
A
V
V
K
K
M
M
760
|
L
L
K
K
E
E
N
N
A
A
S
S
P
P
S
S
E
E
L
L
770
|
R
R
D
D
L
L
L
L
S
S
E
E
F
F
N
N
V
V
L
L
780
|
K
K
Q
Q
V
V
N
N
H
H
P
P
H
H
V
V
I
I
K
K
790
|
L
L
Y
Y
G
G
A
A
C
C
S
S
Q
Q
D
D
G
G
P
P
800
|
L
L
L
L
L
L
I
I
V
V
E
E
Y
Y
A
A
K
K
Y
Y
810
|
G
G
S
S
L
L
R
R
G
G
F
F
L
L
R
R
E
E
S
S
820
|
R
R
K
K
V
V
G
G
P
P
G
G
Y
Y
L
L
G
G
S
S
830
|
G
G
G
G
S
S
R
R
N
N
S
S
S
S
S
S
L
L
D
D
840
|
H
H
P
P
D
D
E
E
R
R
A
A
L
L
T
T
M
M
G
G
850
|
D
D
L
L
I
I
S
S
F
F
A
A
W
W
Q
Q
I
I
S
S
860
|
Q
Q
G
G
M
M
Q
Q
Y
Y
L
L
A
A
E
E
M
M
K
K
870
|
L
L
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
880
|
I
I
L
L
V
V
A
A
E
E
G
G
R
R
K
K
M
M
K
K
890
|
I
I
S
S
D
D
F
F
G
G
L
L
S
S
R
R
D
D
V
V
900
|
Y
Y
E
E
E
E
D
D
S
S
Y
Y
V
V
K
K
R
R
S
S
910
|
Q
Q
G
G
R
R
I
I
P
P
V
V
K
K
W
W
M
T
A
A
920
|
I
I
E
E
S
S
L
L
F
F
D
D
H
H
I
I
Y
Y
T
T
930
|
T
T
Q
Q
S
S
D
D
V
V
W
W
S
S
F
F
G
G
V
V
940
|
L
L
L
L
W
W
E
E
I
I
V
V
T
T
L
L
G
G
G
G
950
|
N
N
P
P
Y
Y
P
P
G
G
I
I
P
P
P
P
E
E
R
R
960
|
L
L
F
F
N
N
L
L
L
L
K
K
T
T
G
G
H
H
R
R
970
|
M
M
E
E
R
R
P
P
D
D
N
N
C
C
S
S
E
E
E
E
980
|
M
M
Y
Y
R
R
L
L
M
M
L
L
Q
Q
C
C
W
W
K
K
990
|
Q
Q
E
E
P
P
D
D
K
K
R
R
P
P
V
V
F
F
A
A
1000
|
D
D
I
I
S
S
K
K
D
D
L
L
E
E
K
K
M
M
M
M
1010
|
V
V
K
K
R
R
R
R
Click to Show/Hide the Structure
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model HEK293 cells Kidney Homo sapiens (Human) CVCL_0045
TPC-1 cells Thyroid Homo sapiens (Human) CVCL_6298
MZ-CRC-1 cells Pleural effusion Homo sapiens (Human) CVCL_A656
MTC-TT cells Thyroid gland Homo sapiens (Human) CVCL_1774
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 MTT assay
Mechanism Description The missense mutation p.M918T (c.2753T>C) in gene RET cause the sensitivity of Cabozantinib by aberration of the drug's therapeutic target
Key Molecule: Proto-oncogene tyrosine-protein kinase receptor Ret (RET) [9]
Sensitive Disease Thyroid gland cancer [ICD-11: 2D10.0]
 Disease Info 
Molecule Alteration Missense mutation
p.M918T (c.2753T>C)
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.64  Å
PDB: 7DUA
Mutant Type Structure Method: X-ray diffraction Resolution: 2.12  Å
PDB: 4CKI
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.93
TM score: 0.95555
Amino acid change:
M918T
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
700
|
G
G
P
P
L
L
S
S
L
L
S
S
V
V
D
D
A
A
F
F
710
|
K
K
I
I
L
L
E
E
D
D
P
P
K
K
W
W
E
E
F
F
720
|
P
P
R
R
K
K
N
N
L
L
V
V
L
L
G
G
K
K
T
T
730
|
L
L
G
G
E
E
G
G
E
E
F
F
G
G
K
K
V
V
V
V
740
|
K
K
A
A
T
T
A
A
F
F
H
H
L
L
K
K
G
G
R
R
750
|
A
A
G
G
Y
Y
T
T
T
T
V
V
A
A
V
V
K
K
M
M
760
|
L
L
K
K
E
E
N
N
A
A
S
S
P
P
S
S
E
E
L
L
770
|
R
R
D
D
L
L
L
L
S
S
E
E
F
F
N
N
V
V
L
L
780
|
K
K
Q
Q
V
V
N
N
H
H
P
P
H
H
V
V
I
I
K
K
790
|
L
L
Y
Y
G
G
A
A
C
C
S
S
Q
Q
D
D
G
G
P
P
800
|
L
L
L
L
L
L
I
I
V
V
E
E
Y
Y
A
A
K
K
Y
Y
810
|
G
G
S
S
L
L
R
R
G
G
F
F
L
L
R
R
E
E
S
S
820
|
R
R
K
K
V
V
G
G
P
P
G
G
Y
Y
L
L
G
G
S
S
830
|
G
G
G
G
S
S
R
R
N
N
S
S
S
S
S
S
L
L
D
D
840
|
H
H
P
P
D
D
E
E
R
R
A
A
L
L
T
T
M
M
G
G
850
|
D
D
L
L
I
I
S
S
F
F
A
A
W
W
Q
Q
I
I
S
S
860
|
Q
Q
G
G
M
M
Q
Q
Y
Y
L
L
A
A
E
E
M
M
K
K
870
|
L
L
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
880
|
I
I
L
L
V
V
A
A
E
E
G
G
R
R
K
K
M
M
K
K
890
|
I
I
S
S
D
D
F
F
G
G
L
L
S
S
R
R
D
D
V
V
900
|
Y
Y
E
E
E
E
D
D
S
S
Y
Y
V
V
K
K
R
R
S
S
910
|
Q
Q
G
G
R
R
I
I
P
P
V
V
K
K
W
W
M
T
A
A
920
|
I
I
E
E
S
S
L
L
F
F
D
D
H
H
I
I
Y
Y
T
T
930
|
T
T
Q
Q
S
S
D
D
V
V
W
W
S
S
F
F
G
G
V
V
940
|
L
L
L
L
W
W
E
E
I
I
V
V
T
T
L
L
G
G
G
G
950
|
N
N
P
P
Y
Y
P
P
G
G
I
I
P
P
P
P
E
E
R
R
960
|
L
L
F
F
N
N
L
L
L
L
K
K
T
T
G
G
H
H
R
R
970
|
M
M
E
E
R
R
P
P
D
D
N
N
C
C
S
S
E
E
E
E
980
|
M
M
Y
Y
R
R
L
L
M
M
L
L
Q
Q
C
C
W
W
K
K
990
|
Q
Q
E
E
P
P
D
D
K
K
R
R
P
P
V
V
F
F
A
A
1000
|
D
D
I
I
S
S
K
K
D
D
L
L
E
E
K
K
M
M
M
M
1010
|
V
V
K
K
R
R
R
R
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
Multiple endocrine neoplasia [ICD-11: 2F7A]
Click to Show/Hide
Drug Resistance Data Categorized by Their Corresponding Mechanisms
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Proto-oncogene tyrosine-protein kinase receptor Ret (RET) [1]
Resistant Disease Multiple endocrine neoplasia [ICD-11: 2F7A.0]
 Disease Info 
Molecule Alteration Missense mutation
p.M918T
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.64  Å
PDB: 7DUA
Mutant Type Structure Method: X-ray diffraction Resolution: 2.12  Å
PDB: 4CKI
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.93
TM score: 0.95555
Amino acid change:
M918T
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
700
|
G
G
P
P
L
L
S
S
L
L
S
S
V
V
D
D
A
A
F
F
710
|
K
K
I
I
L
L
E
E
D
D
P
P
K
K
W
W
E
E
F
F
720
|
P
P
R
R
K
K
N
N
L
L
V
V
L
L
G
G
K
K
T
T
730
|
L
L
G
G
E
E
G
G
E
E
F
F
G
G
K
K
V
V
V
V
740
|
K
K
A
A
T
T
A
A
F
F
H
H
L
L
K
K
G
G
R
R
750
|
A
A
G
G
Y
Y
T
T
T
T
V
V
A
A
V
V
K
K
M
M
760
|
L
L
K
K
E
E
N
N
A
A
S
S
P
P
S
S
E
E
L
L
770
|
R
R
D
D
L
L
L
L
S
S
E
E
F
F
N
N
V
V
L
L
780
|
K
K
Q
Q
V
V
N
N
H
H
P
P
H
H
V
V
I
I
K
K
790
|
L
L
Y
Y
G
G
A
A
C
C
S
S
Q
Q
D
D
G
G
P
P
800
|
L
L
L
L
L
L
I
I
V
V
E
E
Y
Y
A
A
K
K
Y
Y
810
|
G
G
S
S
L
L
R
R
G
G
F
F
L
L
R
R
E
E
S
S
820
|
R
R
K
K
V
V
G
G
P
P
G
G
Y
Y
L
L
G
G
S
S
830
|
G
G
G
G
S
S
R
R
N
N
S
S
S
S
S
S
L
L
D
D
840
|
H
H
P
P
D
D
E
E
R
R
A
A
L
L
T
T
M
M
G
G
850
|
D
D
L
L
I
I
S
S
F
F
A
A
W
W
Q
Q
I
I
S
S
860
|
Q
Q
G
G
M
M
Q
Q
Y
Y
L
L
A
A
E
E
M
M
K
K
870
|
L
L
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
880
|
I
I
L
L
V
V
A
A
E
E
G
G
R
R
K
K
M
M
K
K
890
|
I
I
S
S
D
D
F
F
G
G
L
L
S
S
R
R
D
D
V
V
900
|
Y
Y
E
E
E
E
D
D
S
S
Y
Y
V
V
K
K
R
R
S
S
910
|
Q
Q
G
G
R
R
I
I
P
P
V
V
K
K
W
W
M
T
A
A
920
|
I
I
E
E
S
S
L
L
F
F
D
D
H
H
I
I
Y
Y
T
T
930
|
T
T
Q
Q
S
S
D
D
V
V
W
W
S
S
F
F
G
G
V
V
940
|
L
L
L
L
W
W
E
E
I
I
V
V
T
T
L
L
G
G
G
G
950
|
N
N
P
P
Y
Y
P
P
G
G
I
I
P
P
P
P
E
E
R
R
960
|
L
L
F
F
N
N
L
L
L
L
K
K
T
T
G
G
H
H
R
R
970
|
M
M
E
E
R
R
P
P
D
D
N
N
C
C
S
S
E
E
E
E
980
|
M
M
Y
Y
R
R
L
L
M
M
L
L
Q
Q
C
C
W
W
K
K
990
|
Q
Q
E
E
P
P
D
D
K
K
R
R
P
P
V
V
F
F
A
A
1000
|
D
D
I
I
S
S
K
K
D
D
L
L
E
E
K
K
M
M
M
M
1010
|
V
V
K
K
R
R
R
R
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model BaF3 cells Bone Mus musculus (Mouse) CVCL_0161
Experiment for
Molecule Alteration		 qRT-PCR
Experiment for
Drug Resistance		 LC50 assay
Mechanism Description M918T is a RET mutation prevalent in aggressive multiple endocrine neoplasia type 2B. M918T mutation is located at distant sites away from the TKI binding pocket. IC50s of cabozantinib, lenvatinib, vandetanib and nintedanib in BaF3/KR (M918T) cells were 6.5-fold, 7.5-fold, 4.3-fold and 1.7-fold, respectively, higher than in BaF3/KR cells.
Key Molecule: Proto-oncogene tyrosine-protein kinase receptor Ret (RET) [1]
Resistant Disease Multiple endocrine neoplasia [ICD-11: 2F7A.0]
 Disease Info 
Molecule Alteration Missense mutation
p.M918T
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.64  Å
PDB: 7DUA
Mutant Type Structure Method: X-ray diffraction Resolution: 2.12  Å
PDB: 4CKI
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.93
TM score: 0.95555
Amino acid change:
M918T
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
700
|
G
G
P
P
L
L
S
S
L
L
S
S
V
V
D
D
A
A
F
F
710
|
K
K
I
I
L
L
E
E
D
D
P
P
K
K
W
W
E
E
F
F
720
|
P
P
R
R
K
K
N
N
L
L
V
V
L
L
G
G
K
K
T
T
730
|
L
L
G
G
E
E
G
G
E
E
F
F
G
G
K
K
V
V
V
V
740
|
K
K
A
A
T
T
A
A
F
F
H
H
L
L
K
K
G
G
R
R
750
|
A
A
G
G
Y
Y
T
T
T
T
V
V
A
A
V
V
K
K
M
M
760
|
L
L
K
K
E
E
N
N
A
A
S
S
P
P
S
S
E
E
L
L
770
|
R
R
D
D
L
L
L
L
S
S
E
E
F
F
N
N
V
V
L
L
780
|
K
K
Q
Q
V
V
N
N
H
H
P
P
H
H
V
V
I
I
K
K
790
|
L
L
Y
Y
G
G
A
A
C
C
S
S
Q
Q
D
D
G
G
P
P
800
|
L
L
L
L
L
L
I
I
V
V
E
E
Y
Y
A
A
K
K
Y
Y
810
|
G
G
S
S
L
L
R
R
G
G
F
F
L
L
R
R
E
E
S
S
820
|
R
R
K
K
V
V
G
G
P
P
G
G
Y
Y
L
L
G
G
S
S
830
|
G
G
G
G
S
S
R
R
N
N
S
S
S
S
S
S
L
L
D
D
840
|
H
H
P
P
D
D
E
E
R
R
A
A
L
L
T
T
M
M
G
G
850
|
D
D
L
L
I
I
S
S
F
F
A
A
W
W
Q
Q
I
I
S
S
860
|
Q
Q
G
G
M
M
Q
Q
Y
Y
L
L
A
A
E
E
M
M
K
K
870
|
L
L
V
V
H
H
R
R
D
D
L
L
A
A
A
A
R
R
N
N
880
|
I
I
L
L
V
V
A
A
E
E
G
G
R
R
K
K
M
M
K
K
890
|
I
I
S
S
D
D
F
F
G
G
L
L
S
S
R
R
D
D
V
V
900
|
Y
Y
E
E
E
E
D
D
S
S
Y
Y
V
V
K
K
R
R
S
S
910
|
Q
Q
G
G
R
R
I
I
P
P
V
V
K
K
W
W
M
T
A
A
920
|
I
I
E
E
S
S
L
L
F
F
D
D
H
H
I
I
Y
Y
T
T
930
|
T
T
Q
Q
S
S
D
D
V
V
W
W
S
S
F
F
G
G
V
V
940
|
L
L
L
L
W
W
E
E
I
I
V
V
T
T
L
L
G
G
G
G
950
|
N
N
P
P
Y
Y
P
P
G
G
I
I
P
P
P
P
E
E
R
R
960
|
L
L
F
F
N
N
L
L
L
L
K
K
T
T
G
G
H
H
R
R
970
|
M
M
E
E
R
R
P
P
D
D
N
N
C
C
S
S
E
E
E
E
980
|
M
M
Y
Y
R
R
L
L
M
M
L
L
Q
Q
C
C
W
W
K
K
990
|
Q
Q
E
E
P
P
D
D
K
K
R
R
P
P
V
V
F
F
A
A
1000
|
D
D
I
I
S
S
K
K
D
D
L
L
E
E
K
K
M
M
M
M
1010
|
V
V
K
K
R
R
R
R
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model BaF3 cells Bone Mus musculus (Mouse) CVCL_0161
Experiment for
Molecule Alteration		 qRT-PCR
Experiment for
Drug Resistance		 LC50 assay
Mechanism Description M918T is a RET mutation prevalent in aggressive multiple endocrine neoplasia type 2B. M918T mutation is located at distant sites away from the TKI binding pocket. IC50s of cabozantinib, lenvatinib, vandetanib and nintedanib in BaF3/KR (M918T) cells were 6.5-fold, 7.5-fold, 4.3-fold and 1.7-fold, respectively, higher than in BaF3/KR cells.
References
Ref 1 Drug resistance profiles of mutations in the RET kinase domain .Br J Pharmacol. 2018 Sep;175(17):3504-3515. doi: 10.1111/bph.14395. Epub 2018 Jul 19. 10.1111/bph.14395
Ref 2 Immune cell mediated cabozantinib resistance for patients with renal cell carcinoma .Integr Biol (Camb). 2021 Dec 30;13(11):259-268. doi: 10.1093/intbio/zyab018. 10.1093/intbio/zyab018
Ref 3 Knockdown of FBI-1 Inhibits the Warburg Effect and Enhances the Sensitivity of Hepatocellular Carcinoma Cells to Molecular Targeted Agents via miR-3692/HIF-1alpha. Front Oncol. 2021 Nov 12;11:796839.
Ref 4 Acquired Resistance to Crizotinib in NSCLC with MET Exon 14 Skipping. J Thorac Oncol. 2016 Aug;11(8):1242-1245. doi: 10.1016/j.jtho.2016.06.013. Epub 2016 Jun 22.
Ref 5 Flumatinib, a selective inhibitor of BCR-ABL/PDGFR/KIT, effectively overcomes drug resistance of certain KIT mutantsCancer Sci. 2014 Jan;105(1):117-25. doi: 10.1111/cas.12320. Epub 2014 Jan 4.
Ref 6 Acquired METD1228V Mutation and Resistance to MET Inhibition in Lung Cancer. Cancer Discov. 2016 Dec;6(12):1334-1341. doi: 10.1158/2159-8290.CD-16-0686. Epub 2016 Sep 30.
Ref 7 Acquired MET Y1248H and D1246N Mutations Mediate Resistance to MET Inhibitors in Non-Small Cell Lung CancerClin Cancer Res. 2017 Aug 15;23(16):4929-4937. doi: 10.1158/1078-0432.CCR-16-3273. Epub 2017 Apr 10.
Ref 8 The effects of four different tyrosine kinase inhibitors on medullary and papillary thyroid cancer cellsJ Clin Endocrinol Metab. 2011 Jun;96(6):E991-5. doi: 10.1210/jc.2010-2381. Epub 2011 Apr 6.
Ref 9 Correlative analyses of RET and RAS mutations in a phase 3 trial of cabozantinib in patients with progressive, metastatic medullary thyroid cancerCancer. 2016 Dec 15;122(24):3856-3864. doi: 10.1002/cncr.30252. Epub 2016 Aug 15.

If you find any error in data or bug in web service, please kindly report it to Dr. Sun and Dr. Yu.