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BMC Cancer
Published in: BMC Cancer 1/2020

01-12-2020 | NSCLC | Research article

Mutational spectrum of acquired resistance to reversible versus irreversible EGFR tyrosine kinase inhibitors

Authors: Svenja Wagener-Ryczek, Carina Heydt, Juliane Süptitz, Sebastian Michels, Markus Falk, Christina Alidousty, Jana Fassunke, Michaela Angelika Ihle, Markus Tiemann, Lukas Heukamp, Jürgen Wolf, Reinhard Büttner, Sabine Merkelbach-Bruse

Published in: BMC Cancer | Issue 1/2020

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Abstract

Background

Over the past years, EGFR tyrosine kinase inhibitors (TKI) revolutionized treatment response. 1st-generation (reversible) EGFR TKI and later the 2nd –generation irreversible EGFR TKI Afatinib were aimed to improve treatment response. Nevertheless, diverse resistance mechanisms develop within the first year of therapy. Here, we evaluate the prevalence of acquired resistance mechanisms towards reversible and irreversible EGFR TKI.

Methods

Rebiopsies of patients after progression to EGFR TKI therapy (> 6 months) were targeted to histological and molecular analysis. Multiplexed targeted sequencing (NGS) was conducted to identify acquired resistance mutations (e.g. EGFR p.T790M). Further, Fluorescence in situ hybridisation (FISH) was applied to investigate the status of bypass mechanisms like, MET or HER2 amplification.

Results

One hundred twenty-three rebiopsy samples of patients that underwent first-line EGFR TKI therapy (PFS ≥6 months) were histologically and molecularly profiled upon clinical progression. The EGFR p.T790M mutation is the major mechanism of acquired resistance in patients treated with reversible as well as irreversible EGFR TKI. Nevertheless a statistically significant difference for the acquisition of T790M mutation has been identified: 45% of afatinib- vs 65% of reversible EGFR TKI treated patients developed a T790M mutation (p-value 0.02). Progression free survival (PFS) was comparable in patients treated with irreversible EGFR irrespective of the sensitising primary mutation or the acquisition of p.T790M.

Conclusions

The EGFR p.T790M mutation is the most prominent mechanism of resistance to reversible and irreversible EGFR TKI therapy. Nevertheless there is a statistically significant difference of p.T790M acquisition between the two types of TKI, which might be of importance for clinical therapy decision.
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Metadata
Title
Mutational spectrum of acquired resistance to reversible versus irreversible EGFR tyrosine kinase inhibitors
Authors
Svenja Wagener-Ryczek
Carina Heydt
Juliane Süptitz
Sebastian Michels
Markus Falk
Christina Alidousty
Jana Fassunke
Michaela Angelika Ihle
Markus Tiemann
Lukas Heukamp
Jürgen Wolf
Reinhard Büttner
Sabine Merkelbach-Bruse
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2020
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-020-06920-3

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