Liao and van Linden et al divided the

Liao [47] and van Linden et al. [48] divided the gap between the N-terminal and C-terminal lobes into a front cleft or pocket, a gate area, and a back cleft. The back pocket corresponds to the gate area and the back cleft. The front cleft includes the Gly-rich loop, the hinge, the linker connecting the hinge with the αD-helix in the large lobe, and residues within the catalytic loop. The gate area includes residues within the β-3 strand and the initial portion of the activation segment including DFG. They also described several sub-pockets within these three regions. For example, the front cleft contains an LLY507 receptor pocket (AP) adjacent to FP-I and FP-II subpockets and the gate area contains BP-I-A and BP-I-B subpockets. The back cleft consists of the αC-helix, the αC-β4 loop, portions of the β-4 and β-5 strands, and portions of the αE-helix. Crizotinib binds to the ALK front pocket and the FP-I subpocket. We previously divided type I½ inhibitors into two classes: A and B. The type A inhibitors extend into the back pocket while the type B inhibitors do not. Because crizotinib does not extend into the back pocket it is classified as a type I½ B inhibitor. van Linden et al. provided a comprehensive summary of ligand and drug binding to more than 1200 human and mouse protein kinase catalytic domains deposited in the protein data bank [48]. Their KLIFS catalogue (kinase–ligand interaction fingerprint and structure) reports on the alignment of 85 protein kinase-ligand binding-site residues, which facilitates the recognition of family specific interaction features as well as the classification of ligands according to their binding properties. These investigators employ a standard residue numbering system that facilitates a comparison among all protein kinases. See Table 2 for the correspondence between the C-spine, Shell, and R-spine residues and the KLIFS residues. Moreover, van Linden et al. have established a valuable noncommercial and searchable web site that provides updated information on protein kinase-ligand interactions (http://www.vu-compmedchem.nl/). Crizotinib was the first FDA-approved small molecule antagonist used for the treatment of ALK+-NSCLC with a response rate of about 60% indicating that primary resistance occurs in 40% of patients [53], [54], [55], [56]. Additionally, acquired or secondary resistance occurs in the 60% of those patients that respond with a median duration of about 10.5 months after the initiation of treatment. Acquired resistance in about one-third of the cases is due to mutations or overexpression of EML4-ALK fusion proteins, another third is due to up-regulation of alternative bypass signaling pathways, and the mechanisms for the final third is unknown. The L1196M gatekeeper mutation is the most common ALK mutation conferring crizotinib resistance while other resistance mutations include I1171T, F1174C, G1202R, S1206Y, and G1269A [53]. Such drug-resistant mutations prompted the development of second generation ALK inhibitors such as ceritinib and alectinib. Ceritinib is a second generation medicinal [57] that is approved by the FDA for the treatment ALK+-NSCLC in patients who have developed resistance or are intolerant to crizotinib. Ceritinib overcomes ALK-bearing I1171T, L1196M, S1206Y, and G1269A mutations, but not ALK with F1174C or G1202R mutations [7], [50], [54]. The ceritinib crystal structure depicts a binding pattern similar to that of the ALK–crizotinib complex with a compact activation segment conformation corresponding to a dormant enzyme [56], which indicates that it is a type I½ B inhibitor of ALK. The N3 of the pyrimidine (Fig. 5B) forms a hydrogen bond with the NH of M1199 and the NH of the 2-aminopyrimidine forms a hydrogen bond with the M1199 carbonyl within the ALK hinge (Fig. 6B). A water molecule forms hydrogen bonds with β3-K1150 and one of the sulfonyl oxygens (not shown). Ceritinib makes hydrophobic contacts with the β1-strand L1122, H1124 within the G-rich loop, V1130 (CS7) after the G-rich loop, A1148 (CS8), β3-K1150, the gatekeeper L1196 (Sh2), the 1198LMA1200 triad of the hinge, and L1256 (CS6). The 5-chloropyridine and sulfonylphenyl drug fragments make hydrophobic contact with L1122, A1148 and H1124 in the ceiling of the cleft. The terminal 2-isopropoxy-3-(piperidin-4-yl)phenyl group lies between the solvent and the ATP-binding cleft. Ceritinib inhibits InsRK, IGF-1RK, and ROS1 protein kinase with an inhibitor profile that partially overlaps that of crizotinib. Ceritinib binds in the ALK front cleft (the adenine pocket and FP-I) without extending to the back cleft [48]. The L1196M gatekeeper mutation of ALK is one of the mechanisms responsible for the acquired resistance to crizotinib and its inhibition by ceritinib thus represents an important FDA-approved second-line therapy for crizotinib-resistant ALK+-NSCLC.