From the “one-size-fits-all” approach of chemotherapy and radiotherapy to today’s “tailor-made” precision medicine, cancer treatment has officially entered the “stratification era.” Diseases are no longer defined simply by the site of origin, but by decoding molecular characteristics and identifying key driver mutations that fuel tumor growth. 

This enables “different treatments for the same disease” and even “similar treatments for different diseases.” Among these advances, breakthroughs in key targets such as KRAS and EGFR have overcome traditional treatment bottlenecks and become central engines of precision oncology.

Moving Beyond “Broad Treatment”: The Core Logic of the Stratification Era

Before the rise of precision medicine, cancer treatment largely followed a “broad-spectrum” model. Patients with tumors at the same site and stage typically received uniform chemotherapy or radiotherapy. This often led to significant side effects, limited efficacy, and frequent drug resistance, creating a vicious cycle.

The essence of the stratification era lies in recognizing that cancer is fundamentally a “molecular disease.” Even tumors originating from the same organ can differ greatly at the molecular level. By identifying driver mutations through genetic testing and applying targeted therapies accordingly, clinicians can achieve precise tumor control while improving both efficacy and safety.

This shift is akin to moving from “carpet bombing” to “precision targeting.” For example, before stratification, the response rate of chemotherapy in advanced non-small cell lung cancer (NSCLC) was less than 30%. In contrast, patients with EGFR or KRAS mutations receiving targeted therapy can achieve response rates of over 70%, significantly improving survival and quality of life and fundamentally transforming the treatment landscape.

Breakthrough Targets: KRAS and EGFR Redefine Treatment Paradigms

KRAS and EGFR are among the most critical driver genes in oncology, widely present in cancers such as lung cancer and colorectal cancer. Their mutation status directly determines treatment strategies and prognosis, and drug development targeting these genes exemplifies the rapid progress of precision medicine.

EGFR Mutations: The Pioneer of Targeted Therapy

EGFR mutations occur in up to 50% of Asian patients with lung adenocarcinoma. These mutations lead to continuous activation of signaling pathways that drive uncontrolled tumor growth.

EGFR-targeted therapies have evolved through three generations:

●  First-generation inhibitors (e.g., gefitinib) broke the monopoly of chemotherapy

●  Second-generation agents improved inhibitory potency

●  Third-generation inhibitors (e.g., osimertinib) overcame resistance mutations such as T790M

This progression has created flexible treatment strategies, including sequential therapy and first-line use of third-generation drugs. As a result, some patients now achieve long-term disease control, effectively transforming lung cancer into a manageable chronic condition.

KRAS Mutations: From “Undruggable” to Targetable

KRAS was one of the first oncogenes discovered and is highly prevalent in cancers such as pancreatic cancer (over 90%) and colorectal cancer (around 40%). Due to its smooth protein surface lacking clear binding sites, KRAS was long considered “undruggable,” with decades of unsuccessful research efforts.

This impasse was broken when researchers identified a hidden binding pocket in the KRAS G12C mutation. The approval of China’s first KRAS G12C inhibitor marked a major milestone, demonstrating strong clinical efficacy in heavily pretreated patients, with encouraging response and disease control rates.

In 2025, the drug was included in the national reimbursement system, significantly reducing its cost and making targeted therapy more accessible and affordable. Meanwhile, next-generation pan-KRAS inhibitors and combination strategies are under active development, aiming to further expand treatment options.

Opportunities and Challenges in the Stratification Era

While breakthroughs in KRAS and EGFR have propelled oncology into the stratification era, the path toward precision medicine still presents both opportunities and challenges.

Opportunities include:

●  Wider adoption and lower costs of genetic testing

●  Continuous discovery of new driver mutations and targeted therapies

●  Advances in gene editing and combination treatment strategies

Challenges include:

1.  Drug resistance remains a major obstacle, as most patients eventually develop secondary resistance

2.  Limited standardization of genetic testing in primary healthcare settings

3.  Lack of therapies for rare mutations

4.  High costs of some precision medicines, despite insurance coverage

Future Outlook: Making Precision Medicine Accessible to All

Looking ahead, the integration of multi-omics technologies and artificial intelligence will further refine molecular classification, enabling the discovery of new targets and the development of truly personalized treatment strategies.

At the same time, ongoing improvements in healthcare policy and drug development are expected to reduce treatment costs and expand access to genetic testing, allowing patients in remote regions to benefit from precision medicine.

In addition, continued exploration of combination therapies—integrating targeted therapy with immunotherapy and chemotherapy—will help overcome resistance and improve outcomes. More patients may achieve long-term survival or even clinical remission.

From broad treatment to precise stratification, the breakthroughs in KRAS, EGFR, and other targets mark only the beginning. The future of oncology lies in delivering effective, personalized care to every patient, ultimately reducing the global burden of cancer.

Against this backdrop, the importance of pharmaceutical distribution systems has become increasingly evident. Companies such as DengYue Pharma play a vital role by integrating global innovative drug resources and establishing compliant cross-border supply networks.

Although not directly involved in drug development, these organizations serve as critical bridges between innovation and patients. By shortening the time from drug approval to clinical use, they help ensure that advanced therapies—including KRAS- and EGFR-targeted treatments—reach patients more efficiently and effectively.