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Mutational spectrum of acquired resistance to reversible versus irreversible EGFR tyrosine kinase inhibitors.
- Source :
-
BMC cancer [BMC Cancer] 2020 May 12; Vol. 20 (1), pp. 408. Date of Electronic Publication: 2020 May 12. - Publication Year :
- 2020
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Adult
Aged
Aged, 80 and over
Biomarkers, Tumor genetics
Carcinoma, Non-Small-Cell Lung drug therapy
Carcinoma, Non-Small-Cell Lung genetics
ErbB Receptors genetics
Female
Follow-Up Studies
Humans
Lung Neoplasms drug therapy
Lung Neoplasms genetics
Male
Middle Aged
Molecular Targeted Therapy
Prognosis
Retrospective Studies
Survival Rate
Carcinoma, Non-Small-Cell Lung pathology
Drug Resistance, Neoplasm
Lung Neoplasms pathology
Mutation
Protein Kinase Inhibitors pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2407
- Volume :
- 20
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cancer
- Publication Type :
- Academic Journal
- Accession number :
- 32397977
- Full Text :
- https://doi.org/10.1186/s12885-020-06920-3