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Targeting the undruggable oncogenic KRAS: the dawn of hope
Hande Asimgil, Utku Ertetik, Nedim Can Çevik, Menar Ekizce, Alper Doğruöz, Muazzez Gökalp, Elif Arık-Sever, Rouzanna Istvanffy, Helmut Friess, Güralp Onur Ceyhan, Ihsan Ekin Demir
Hande Asimgil, Utku Ertetik, Nedim Can Çevik, Menar Ekizce, Alper Doğruöz, Muazzez Gökalp, Elif Arık-Sever, Rouzanna Istvanffy, Helmut Friess, Güralp Onur Ceyhan, Ihsan Ekin Demir
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Targeting the undruggable oncogenic KRAS: the dawn of hope

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Abstract

KRAS mutations are the drivers of various cancers, including non–small cell lung cancer, colon cancer, and pancreatic cancer. Over the last 30 years, immense efforts have been made to inhibit KRAS mutants and oncogenic KRAS signaling using inhibitors. Recently, specific targeting of KRAS mutants with small molecules revived the hopes for successful therapies for lung, pancreatic, and colorectal cancer patients. Moreover, advances in gene editing, protein engineering, and drug delivery formulations have revolutionized cancer therapy regimens. New therapies aim to improve immune surveillance and enhance antitumor immunity by precisely targeting cancer cells harboring oncogenic KRAS. Here, we review recent KRAS-targeting strategies, their therapeutic potential, and remaining challenges to overcome. We also highlight the potential synergistic effects of various combinatorial therapies in preclinical and clinical trials.

Authors

Hande Asimgil, Utku Ertetik, Nedim Can Çevik, Menar Ekizce, Alper Doğruöz, Muazzez Gökalp, Elif Arık-Sever, Rouzanna Istvanffy, Helmut Friess, Güralp Onur Ceyhan, Ihsan Ekin Demir

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Figure 1

RNAi and CRISPR technology for treatment of oncogenic KRAS–driven cancers.

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RNAi and CRISPR technology for treatment of oncogenic KRAS–driven cancer...
(A) Mutant KRAS–specific (mKRAS-specific) siRNAs and shRNAs silence the expression of mKRAS by generating an RNA hybrid complex that induces endogenous KRAS mRNA degradation. Inhibitory RNA molecules are encapsulated in a liposome, exosome, or nanoparticle and can be administered to patients via intravenous injection or orthotopic injections for access to oncogenic KRAS–driven tumor sites. Alternatively, adeno-associated viral (AAV) vectors may be used to intravenously deliver mKRAS-targeting therapeutics. Despite major safety concerns, viral vector delivery systems (adenoviral, retroviral, and lentiviral vectors) provide longer-lasting effects on RAS hotspot mutations. (B) Viral delivery of CRISPR/Cas9 (DNA) or Cas13 (RNA) systems that target mKRAS-expressing tumor cells is administered to the tumoral site via orthotopic injection. Through administration of KRAS sgRNAs in the CRISPR/Cas13 system, only transient correction of cancer cells at the post-transcriptional level can be attained. By directly targeting mKRAS, both RNAi- and CRISPR-based therapeutics promote tumor reduction.

Copyright © 2026 American Society for Clinical Investigation
ISSN 2379-3708

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