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Machado-Rugolo J, Baldavira C, Prieto T, Olivieri E, Fabro A, Rainho C, Castelli E, Ribolla P, Ab'Saber A, Takagaki T, Nagai M, Capelozzi V. Clinical outcome of Brazilian patients with non-small cell lung cancer in early stage harboring rare mutations in epidermal growth factor receptor. Braz J Med Biol Res 2023; 55:e12409. [PMID: 36629526 PMCID: PMC9828871 DOI: 10.1590/1414-431x2022e12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/09/2022] [Indexed: 01/11/2023] Open
Abstract
The common epidermal growth factor receptor (EGFR) mutations, such as the L858R point mutation in exon 21 and the in-frame deletional mutation in exon 19, have been definitively associated with response to EGFR-tyrosine kinase inhibitors (EGFR-TKI). However, the clinical outcome and response to treatment for many other rarer mutations are still unclear. In this study, we report the results of Brazilian patients in stage IB-IIIA non-small cell lung cancer (NSCLC) following complete resection with minimal residual disease and EGFR mutations treated with adjuvant chemotherapy and/or EGFR-TKIs. The frequency of EGFR mutations was investigated in 70 cases of early stage NSCLC. Mutations in exons 18 and 20, uncommon mutations in exons 19 and 21, as well as in exons 3, 7, 14, 16, 22, 27, and 28, and/or the presence of different mutations in a single tumor (complex mutations) are considered rare. EGFR mutations were detected in 23 tumors (32.9%). Fourteen cases carried rare mutations and were treated with platinum-based chemotherapy and two cases were treated with erlotinib. The clinical outcome is described case by case with references to the literature. Notably, we found two rare EGFR mutations and one of them with an unknown response to chemotherapy and/or EGFR-TKIs. We have provided complementary information concerning the clinical outcome and treatment of patients with early stage NSCLC for several rare EGFR mutations not previously or only rarely reported. Description of cases harboring rare mutations can support the decision-making process in this subset of patients.
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Affiliation(s)
- J. Machado-Rugolo
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Centro de Avaliação de Tecnologias em Saúde, Hospital das Clínicas de Botucatu, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - C.M. Baldavira
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T.G. Prieto
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E.H.R. Olivieri
- Centro Internacional de Pesquisa/CIPE, AC Camargo Cancer Center, São Paulo, SP, Brasil
| | - A.T. Fabro
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Departamento de Patologia e Medicina Legal, Laboratório de Medicina Respiratória, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C.A. Rainho
- Instituto de Biociências, Departamento de Ciências Químicas e Biológicas, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - E.C. Castelli
- Laboratório de Genética Molecular e Bioinformática, Unidade de Pesquisa Experimental, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil,Departamento de Patologia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - P.E.M. Ribolla
- Instituto de Biotecnologia, Universidade Estadual Paulista, Botucatu, SP, Brasil,Instituto de Biociências, Departamento de Bioestatística, Biologia Vegetal, Parasitologia e Zoologia, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - A.M. Ab'Saber
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T. Takagaki
- Divisão de Pneumologia, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M.A. Nagai
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,Laboratório de Genética Molecular, Centro de Pesquisa Translacional em Oncologia, Instituto do Câncer de São Paulo, São Paulo, SP, Brasil
| | - V.L. Capelozzi
- Laboratório de Histomorfometria e Genômica Pulmonar, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Liu Z, Dong H, Chen W, Wang B, Ji D, Zhang W, Shi X, Feng X. Case Report: Heterogeneity of Resistance Mechanisms in Different Lesions Co-Mediate Acquired Resistance to First-Line Icotinib in EGFR Mutant Non-Small Cell Lung Cancer. Front Med (Lausanne) 2022; 9:906364. [PMID: 35872785 PMCID: PMC9302584 DOI: 10.3389/fmed.2022.906364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 01/12/2023] Open
Abstract
Epidermal growth factor receptor (EGFR)-activating mutations are major oncogenic mechanisms in non-small cell lung cancer (NSCLC). Most patients with NSCLC with EGFR mutations benefit from targeted therapy with EGFR- tyrosine kinase inhibitors (TKIs). One of the main limitations of targeted therapy is that the tumor response is not durable, with the inevitable development of drug resistance. Previous studies demonstrated that the potential resistance mechanisms are diverse, including the presence of EGFR T790M, MET amplification, mesenchymal transformation, and anaplastic lymphoma kinase (ALK) rearrangement. The patient in our report was diagnosed with stage IA lung adenocarcinoma harboring the EGFR L858R mutation and underwent radical surgery. The patient received icotinib for 12 months after recurrence. Subsequent molecular analysis of the left pleural effusion indicated that LCLAT1-ALK fusion might be an underlying mechanism contributing to the acquired resistance to icotinib. Ensartinib was prescribed, but the lesion in the right lung continued to progress. Hence, a re-biopsy and molecular analysis of lesions in the right lung was performed to solve this problem. In contrast to the left pleural effusion, EGFR exon 20 T790M might have mediated the acquired resistance in lesions in the right lung of this patient. The combination of osimertinib and ensartinib has achieved a rapid partial response until now. The complexity and heterogeneity in our case may provide new insights into the resistance mechanisms of targeted therapy.
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Affiliation(s)
- Zhicong Liu
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Hui Dong
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Wenyan Chen
- Department of Respiratory Medicine, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Bin Wang
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Dongxiang Ji
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Wei Zhang
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- Wei Zhang
| | - Xuefei Shi
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- Xuefei Shi
| | - Xueren Feng
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- *Correspondence: Xueren Feng
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