Fibroblast growth factor (FGF) signalling via FGF receptors (FGFR1–4) orchestrates fetal development and contributes to tissue and whole-body homeostasis, but can also promote tumorigenesis. Various agents, including pan-FGFR inhibitors (erdafitinib and futibatinib), FGFR1/2/3 inhibitors (infigratinib and pemigatinib), as well as a range of more-specific agents, have been developed and several have entered clinical use. Erdafitinib is approved for patients with urothelial carcinoma harbouring FGFR2/3 alterations, and futibatinib and pemigatinib are approved for patients with cholangiocarcinoma harbouring FGFR2 fusions and/or rearrangements. Clinical benefit from these agents is in part limited by hyperphosphataemia owing to off-target inhibition of FGFR1 as well as the emergence of resistance mutations in FGFR genes, activation of bypass signalling pathways, concurrent TP53 alterations and possibly epithelial–mesenchymal transition-related isoform switching. The next generation of small-molecule inhibitors, such as lirafugratinib and LOXO-435, and the FGFR2-specific antibody bemarituzumab are expected to have a reduced risk of hyperphosphataemia and the ability to overcome certain resistance mutations. In this Review, we describe the development and current clinical role of FGFR inhibitors and provide perspective on future research directions including expansion of the therapeutic indications for use of FGFR inhibitors, combination of these agents with immune-checkpoint inhibitors and the application of novel technologies, such as artificial intelligence.

成纤维细胞生长因子 (FGF) 信号通过 FGF 受体 (FGFR1-4) 协调胎儿发育，有助于组织和全身稳态，但也可以促进肿瘤发生。各种药物已被开发出来，包括泛 FGFR 抑制剂（erdafitinib 和 futibatinib）、FGFR1/2/3 抑制剂（infigratinib 和 pemigatinib）以及一系列更具特异性的药物，其中一些已进入临床使用。Erdafitinib 被批准用于患有FGFR2/3改变的尿路上皮癌患者，futibatinib 和 pemigatinib 被批准用于患有FGFR2融合和/或重排的胆管癌患者。这些药物的临床益处部分受到高磷酸盐血症的限制，这是由于 FGFR1 的脱靶抑制以及 FGFR 基因中耐药突变的出现、旁路信号通路的激活、同时发生的TP53改变以及可能的上皮-间质转化相关的亚型转换。下一代小分子抑制剂，如lirafugratinib和LOXO-435，以及FGFR2特异性抗体bemarituzumab，预计将降低高磷酸血症的风险，并能够克服某些耐药突变。在这篇综述中，我们描述了 FGFR 抑制剂的发展和当前的临床作用，并提供了对未来研究方向的展望，包括扩大 FGFR 抑制剂的治疗适应症、这些药物与免疫检查点抑制剂的组合以及新技术的应用，比如人工智能。