1
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Trinh JQ, Abughanimeh O. Current management of uncommon EGFR mutations in non-small cell lung cancer. Curr Probl Cancer 2024; 49:101064. [PMID: 38311523 DOI: 10.1016/j.currproblcancer.2024.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
Epidermal growth factor receptor (EGFR) mutations are frequently implicated in non-small cell lung cancer (NSCLC). Though these typically involve exon 19 in-frame deletions or L858R mutations in exon 21, uncommon EGFR mutations comprise 10-15 % of all EGFR mutations. These most frequently include G719X mutations in exon 18, L861Q mutations in exon 21, S768I mutations in exon 20, and in-frame insertions and/or duplications in exon 20. It is crucial to understand these distinct variants and their specific responses to active treatment options to optimize care. In this review, we discuss these uncommon mutations in depth and dissect the current literature regarding their treatment outcomes and subsequent evidence-based management guidelines.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States.
| | - Omar Abughanimeh
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States
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2
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Boukansa S, Mouhrach I, El Agy F, Bouguenouch L, Serraj M, Amara B, Ouadnouni Y, Smahi M, Alami B, Mellas N, Benbrahim Z, El Fatemi H. An epidermal growth factor receptor compound mutation of L858R with S768I in advanced non-small-cell lung cancer: a case report. J Med Case Rep 2024; 18:118. [PMID: 38494473 PMCID: PMC10946199 DOI: 10.1186/s13256-024-04422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND In the current treatment landscape for non-small cell lung cancers, epidermal growth factor receptor-tyrosine kinase inhibitors have emerged as a well-established treatment option for patients with advanced or metastatic disease. This is particularly true for those with commonly occurring epidermal growth factor receptor mutations. However, the therapeutic efficacy of these agents for so-called rare epidermal growth factor receptor mutations, and in particular those characterized by a high degree of complexity, such as double mutations, remains a subject of clinical uncertainty. CASE PRESENTATION In this context, we present the case of a 64-year-old man of Moroccan descent, a lifelong non-smoker, diagnosed with metastatic non-small cell lung cancer characterized by a complex epidermal growth factor receptor mutation encompassing L858R and S768I. The patient subsequently underwent afatinib-based treatment, showing notable clinical results. These included a remarkable overall survival of 51 months, with a median progression-free survival of more than 39 months. CONCLUSIONS This case report is a compelling testimony to the evolving therapeutic landscape of non-small cell lung cancers, providing valuable insight into the potential therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in the realm of rare and complex epidermal growth factor receptor mutations.
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Affiliation(s)
- Sara Boukansa
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Ismail Mouhrach
- Unit of Medical Genetics and Oncogenetics, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Fatima El Agy
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila Bouguenouch
- Unit of Medical Genetics and Oncogenetics, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Bouchra Amara
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nawfel Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Zineb Benbrahim
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hinde El Fatemi
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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3
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Thomas R, Balaram G, Varayathu H, Ghorpade SN, Kowsik PV, Dharman B, Thomas BE, Ramaswamy V, Nanjaiah T, Patil S, Naik R, Basavalinga AK, Ghosh M. Molecular epidemiology and clinical characteristics of epidermal growth factor receptor mutations in NSCLC: A single-center experience from India. J Cancer Res Ther 2023; 19:1398-1406. [PMID: 37787315 DOI: 10.4103/jcrt.jcrt_1986_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background The genetic profiling of non-small cell lung cancer (NSCLC) has contributed to the discovery of actionable targetable mutations, which have significantly improved outcomes in disease with poor prognosis. Molecular epidemiological data of driver mutations in Indian populations have not been extensively elaborated compared to western and eastern Asian NSCLC populations. This study assessed the prevalence and clinical outcomes of EGFR (epidermal growth factor receptor) mutations among the Indian NSCLC cohort in South India. Patients and Methods Retrospective analysis of 2,003 NSCLC patients who had undergone EGFR mutational analysis from 2013 to 2020 was performed. Clinical analysis was performed for 141 patients from 2013 to 2017 using Kaplan-Meier and Chi-square methods. Descriptive and survival statistics were performed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Results EGFR-sensitizing mutations were detected in 41.6% (834/2003) in the study cohort with compound mutations detected in 7.55% (63/834) of EGFR-positive cases. A significant relationship with regard to female gender and EGFR mutation status (P <.001) was observed. Exon 18 G719X (8.7%) mutations and exon 20 T790M point mutation (3.1%) were the most frequently isolated uncommon EGFR mutations. In the clinical cohort, EGFR mutations were detected at a significantly higher prevalence in females (P =0.002) and never-smokers (P < 0.001). EGFR mutation demonstrated a significant relationship with regard to brain metastasis (P = 0.011). EGFR mutated individuals had significantly longer median overall survival compared to EGFR wild type (26 months vs. 12 months, P = 0.044). Conclusion We reports the highest number of EGFR mutation analysis performed from India and mutational analysis indicated a loco-regional variation in India with regard to EGFR mutation frequency and its subtypes.
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Affiliation(s)
- Renjan Thomas
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Gautam Balaram
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Hrish Varayathu
- Department of Translational Medicine and Therapeutics, HCG Hospital, Bangalore, India
| | - Suhas N Ghorpade
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Prarthana V Kowsik
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Baby Dharman
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Beulah Elsa Thomas
- Department of Translational Medicine and Therapeutics, HCG Hospital, Bangalore, India
| | - Veena Ramaswamy
- Department of Histopathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Tejaswini Nanjaiah
- Department of Histopathology, Triesta Sciences, HCG Hospital, Bangalore, India
| | - Shekar Patil
- Department of Medical Oncology, Radiation Oncology, Health Care Global Enterprises Limited, Bangalore, India
| | - Radheysham Naik
- Department of Medical Oncology, Radiation Oncology, Health Care Global Enterprises Limited, Bangalore, India
| | - Ajai Kumar Basavalinga
- Department of Radiation Oncology, Health Care Global Enterprises Limited, Bangalore, India
| | - Mithua Ghosh
- Department of Molecular Pathology, Triesta Sciences, HCG Hospital, Bangalore, India
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4
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Boukansa S, Benbrahim Z, Gamrani S, Mouhrach I, El Agy F, El Bardai S, Bouguenouch L, Serraj M, Amara B, Ouadnouni Y, Smahi M, Alami B, Mellas N, El Fatemi H. Heterogeneous distribution of EGFR mutation in NSCLC: Case report. Respir Med Case Rep 2023; 44:101871. [PMID: 37251359 PMCID: PMC10212754 DOI: 10.1016/j.rmcr.2023.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background We herein report the case of a patient with advanced lung adenocarcinoma who presented a heterogeneous distribution of EGFR mutation. Case report A 74-year-old Moroccan male former smoker was diagnosed with advanced lung adenocarcinoma, harboring S768I exon 20 substitution mutation confirmed by Real Time PCR and Pyrosequencing, but not detected by direct sequencing despite 70% of tumor cells. The present report describes a case of minor histologic intratumoral heterogeneity with heterogeneous distribution of EGFR mutation. Conclusion Both sensitivity and specificity of molecular methods can provide evidence of intratumoral heterogeneity, which may explain the mismatch between the validation of oncology biomarkers and predicting therapeutic response to targeted therapy.
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Affiliation(s)
- Sara Boukansa
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Zineb Benbrahim
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanaa Gamrani
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ismail Mouhrach
- Unit of Medical Genetics and Oncogenetics, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Fatima El Agy
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanae El Bardai
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila Bouguenouch
- Unit of Medical Genetics and Oncogenetics, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Bouchra Amara
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nawfel Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hinde El Fatemi
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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5
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Vaquero J, Pavy A, Gonzalez-Sanchez E, Meredith M, Arbelaiz A, Fouassier L. Genetic alterations shaping tumor response to anti-EGFR therapies. Drug Resist Updat 2022; 64:100863. [DOI: 10.1016/j.drup.2022.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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6
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Cai Y, Wang Y, Sun J, Wang X, Xu Y, Sun C, Guo Y, Sun M, Ma K. Successful treatment of a patient with NSCLC carrying uncommon compound EGFR G719X and S768I mutations using osimertinib: A case report. J Int Med Res 2021; 48:300060520928793. [PMID: 32493093 PMCID: PMC7273558 DOI: 10.1177/0300060520928793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The discovery of epidermal growth factor receptor (EGFR) somatic
mutations and the availability of tyrosine kinase inhibitors (TKIs) as targeted therapies
have altered the therapeutic prospects of advanced non-small-cell lung cancer (NSCLC).
G719X and S768I are uncommon mutations, and they often exist as compound mutations. A few
reports have described the efficacy of first- and second-generation EGFR-TKIs. However,
the efficacy of osimertinib in patients with these uncommon compound mutations is unknown.
In this study, we reported the postoperative outcome of a patient with NSCLC and uncommon
compound EGFR G719X and S768I mutations. After postoperative recurrence,
the patient was treated with osimertinib, and an excellent and long-lasting clinical
response was achieved. The patient has taken osimertinib for 31.0 months and exhibited a
partial response, and her follow-up is ongoing.
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Affiliation(s)
- Yangyang Cai
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yizhuo Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jingnan Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xu Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yinghui Xu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ye Guo
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mengyao Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kewei Ma
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
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7
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Sehgal K, Rangachari D, VanderLaan PA, Kobayashi SS, Costa DB. Clinical Benefit of Tyrosine Kinase Inhibitors in Advanced Lung Cancer with EGFR-G719A and Other Uncommon EGFR Mutations. Oncologist 2020; 26:281-287. [PMID: 32969527 DOI: 10.1002/onco.13537] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/04/2020] [Indexed: 12/18/2022] Open
Abstract
The optimal management of advanced non-small cell lung cancer (NSCLC) with noncanonical epidermal growth factor receptor (EGFR) mutations (i.e., exon 19 deletion and exon 21 L858R) is constrained by the heterogeneous behavior of individual uncommon mutations and limited prospective clinical data in this setting. Despite encouraging results with osimertinib from a recently published phase II trial from South Korea, afatinib remains the only currently approved drug for patients with tumors harboring uncommon EGFR mutations (i.e., S768I, L861Q, and/or G719X). When used at the standard dose of 40 mg daily, afatinib is associated with significant rates of treatment-related adverse events, leading to frequent dose reductions and treatment discontinuations. We report a case of a woman with advanced NSCLC harboring EGFR-G719A mutation treated with afatinib (at an off-label pulse dose strategy that merits further evaluation in prospective studies) with sustained partial response for 20 months with manageable expected toxicities. Subsequent disease progression was mediated by off-target pan-EGFR inhibitor (including osimertinib)-resistant KRAS mutation and not by acquisition of EGFR-T790M. We further present the current state of evidence in the literature behind use of first-, second-, and third-generation tyrosine kinase inhibitors and summarize the evolving spectrum of activity ascribed to osimertinib (and newer EGFR inhibitors with a more favorable therapeutic window and intracranial penetration) in this population of patients with advanced NSCLC and uncommon EGFR mutations. KEY POINTS: Uncommon EGFR mutations characterize a heterogeneous group of patients with advanced non-small cell lung cancer (NSCLC). Afatinib is the only currently U.S. Food and Drug Administration-approved drug for management of advanced NSCLC with uncommon EGFR mutations (S768I, L861Q, and/or G719X). Afatinib treatment at 40 mg daily is associated with high rates of adverse events and dose reductions; alternative strategies including pulse intermittent dosing should be evaluated prospectively. Osimertinib (with favorable safety profile and intracranial penetration) has shown promising results in this population in a phase II trial from South Korea; additional trials are ongoing.
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Affiliation(s)
- Kartik Sehgal
- Division of Medical Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepa Rangachari
- Division of Medical Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Susumu S Kobayashi
- Division of Medical Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel B Costa
- Division of Medical Oncology, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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8
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Passaro A, Malapelle U, Del Re M, Attili I, Russo A, Guerini-Rocco E, Fumagalli C, Pisapia P, Pepe F, De Luca C, Cucchiara F, Troncone G, Danesi R, Spaggiari L, De Marinis F, Rolfo C. Understanding EGFR heterogeneity in lung cancer. ESMO Open 2020; 5:e000919. [PMID: 33067323 PMCID: PMC7569934 DOI: 10.1136/esmoopen-2020-000919] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
The advances in understanding the inherited biological mechanisms of non-small cell lung cancer harbouring epidermal growth factor receptor (EGFR) mutations led to a significant improvement in the outcomes of patients treated with EGFR tyrosine kinase inhibitors. Despite these clinically impressive results, clinical results are not always uniform, suggesting the need for deepening the molecular heterogeneity of this molecularly defined subgroup of patients beyond the clinical and biological surface.The availability of tissue and blood-based tumour genotyping allows us to improve the understanding of molecular and genetic intratumor heterogeneity, driving the measurement of clonal evaluation in patients with lung cancer carrying EGFR mutations. Genetic diversification, clonal expansion and selection are highly variable patterns of genetic diversity, resulting in different biological entities, also a prerequisite for Darwinian selection and therapeutic failure.Such emerging pieces of evidence on the genetic diversity, including adaptive and immunomodulated aspects, provide further evidence for the role of the tumour microenvironment (TME) in drug-resistance and immune-mediated mechanisms. Matching in daily clinical practice, the detailed genomic profile of lung cancer disease and tracking the clonal evolution could be the way to individualise the further target treatments in EGFR-positive disease. Characterising the tumour and immune microenvironment during the time of the cancer evaluation could be the way forward for the qualitative leap needed from bench to bedside. Such a daring approach, aiming at personalising treatment selection in order to exploit the TME properties and weaken tumour adaptivity, should be integrated into clinical trial design to optimise patient outcome.
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Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Marzia Del Re
- Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandro Russo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Caterina Fumagalli
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Caterina De Luca
- Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Federico Cucchiara
- Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Napoli, Campania, Italy
| | - Romano Danesi
- Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Thoracic Surgery,European Insitute of Oncology IRCCS, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Christian Rolfo
- Thoracic Oncology Department and Early Phase Clinical Trials Section, School of Medicine, University of Maryland, Baltimore, MD, United States
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9
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Zhang C, Lin L, Zuo R, Wang Y, Chen P. Response to tyrosine kinase inhibitors in lung adenocarcinoma with the rare epidermal growth factor receptor mutation S768I and G724S: A case report and literature review. Thorac Cancer 2020; 11:2743-2748. [PMID: 32776462 PMCID: PMC7471019 DOI: 10.1111/1759-7714.13606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/25/2022] Open
Abstract
Mutations in the epidermal growth factor receptor (EGFR) are drivers of a subset of lung cancers. In recent years, the treatment of non-small cell lung cancer (NSCLC), especially with EGFR inhibitors, has made rapid progress, and the median progression-free survival (PFS) of patients with EGFR gene-sensitive mutations has been significantly prolonged. However, the response effect of some uncommon EGFR mutations to tyrosine kinase inhibitors (TKIs) remains unclear. Here, we present a patient with multiple EGFR mutations that highlights tumor heterogeneity leading to a mixed molecular response to targeted drugs and emphasizes the complexity of EGFR-driven lung cancer. He received chemotherapy and molecular-targeted treatment including icotinib, afatinib, osimertinib and afatinib + osimertinib. In conclusion, patients with lung adenocarcinoma harboring the EGFR S768I and G724S mutations appear less sensitive to icotinib than patients with sensitive EGFR. However, the patient in our report benefited from treatment with afatinib. Here, we hope to provide information for the treatment of rare and compound mutations in patients.
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Affiliation(s)
- Cuicui Zhang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Department of Thoracic Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan
| | - Li Lin
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Department of Thoracic Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan
| | - Ran Zuo
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Department of Thoracic Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan
| | - Yajie Wang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Department of Thoracic Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan
| | - Peng Chen
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan.,Department of Thoracic Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, Japan
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10
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The significance of epidermal growth factor receptor uncommon mutations in non-small cell lung cancer: A systematic review and critical appraisal. Cancer Treat Rev 2020; 85:101994. [PMID: 32113081 DOI: 10.1016/j.ctrv.2020.101994] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
Uncommon epidermal growth factor receptor (EGFR) mutations collectively account for 10% of EGFR mutations, harboring heterogeneous molecular alterations within exons 18-21 with clinically variable responses to EGFR tyrosine kinase inhibitors (TKIs) in advanced Non-Small Cell Lung Cancer (NSCLC) patients. In addition, with the introduction of different NGS gene approach an improvement of EGFR mutations detection was reported. Today, no specific studies have prospectively evaluated uncommon sensitizing mutations in detail and no firm standard of care has been established in the first-line setting. The aim of this comprehensive review is to critically consider the clinical role of uncommon EGFR mutations highlighting the results of several in vitro and in vivo studies, which singly evaluated the sensitivity of uncommon mutations to currently European of Medicines Agency (EMA)-approved EGFR TKIs in cell lines, xenograft models and humans, in order to obtain a practical guide for refining the clinical decision-making process.
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11
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Cho JH, Lim SH, An HJ, Kim KH, Park KU, Kang EJ, Choi YH, Ahn MS, Lee MH, Sun JM, Lee SH, Ahn JS, Park K, Ahn MJ. Osimertinib for Patients With Non-Small-Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Multicenter, Open-Label, Phase II Trial (KCSG-LU15-09). J Clin Oncol 2020; 38:488-495. [PMID: 31825714 PMCID: PMC7098834 DOI: 10.1200/jco.19.00931] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Approximately 10% of patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) harbor uncommon mutations. Here, we report the efficacy and safety of osimertinib in patients with NSCLC harboring uncommon EGFR mutations. PATIENT AND METHODS This was a multicenter, single-arm, open-label, phase II study in Korea. Patients with histologically confirmed metastatic or recurrent NSCLC harboring EGFR mutations other than the exon 19 deletion, L858R and T790M mutations, and exon 20 insertion were eligible for the study. The primary end point of objective response rate was assessed every 6 weeks by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Secondary end points were progression-free survival, overall survival, duration of response, and safety. RESULTS Between March 2016 and October 2017, 37 patients were enrolled. All were evaluable except one patient who withdrew consent after starting treatment. Median age was 60 years, and 22 (61%) were male. Among patients, 61% received osimertinib as first-line therapy. The mutations identified were G719X (n = 19; 53%), followed by L861Q (n = 9; 25%), S768I (n = 8; 22%), and others (n = 4; 11%). Objective response rate was 50% (18 of 36 patients; 95% CI, 33% to 67%). Median progression-free survival was 8.2 months (95% CI, 5.9 to 10.5 months), and median overall survival was not reached. Median duration of response was 11.2 months (95% CI, 7.7 to 14.7 months). Adverse events of any grade were rash (n = 11; 31%), pruritus (n = 9; 25%), decreased appetite (n = 9; 25%), diarrhea (n = 8; 22%), and dyspnea (n = 8; 22%), but all adverse events were manageable. CONCLUSION Osimertinib demonstrated favorable activity with manageable toxicity in patients with NSCLC harboring uncommon EGFR mutations.
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Affiliation(s)
- Jang Ho Cho
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Incheon St Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung Hee Lim
- Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho Jung An
- St Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Hwan Kim
- Boramae Medical Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keon Uk Park
- Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Eun Joo Kang
- Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Yoon Hee Choi
- Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Mi Sun Ahn
- Ajou University Medical Center, Suwon, Republic of Korea
| | | | - Jong-Mu Sun
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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12
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Chantharasamee J, Poungvarin N, Danchaivijitr P, Techawatanawanna S. Clinical outcome of treatment of metastatic non-small cell lung cancer in patients harboring uncommon EGFR mutation. BMC Cancer 2019; 19:701. [PMID: 31315599 PMCID: PMC6637469 DOI: 10.1186/s12885-019-5913-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022] Open
Abstract
Background Uncommon epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) is a rare subset of NSCLC. The aim of this study was to investigate the prevalence, characteristics, and clinical outcomes of metastatic NSCLC harboring uncommon EGFR mutation at Thailand’s largest national tertiary hospital. The secondary objective was to compare treatment efficacy between EGFR-tyrosine kinase inhibitor (EGFR-TKI) and chemotherapy. Methods This retrospective chart review included patients that were tested for EGFR-mutation NSCLC during 2014–2018. Patient demographic and clinical data, treatment data, and outcome data were collected and analyzed. Results Of the 681 patients that were evaluated for EGFR mutation, 317 (47.0%) had EGFR-mutant NSCLC, and 28 (8.8%) of those harbored uncommon EGFR mutations. The median follow-up was 19.1 months. History of tobacco use was reported in 50% of patients. The most common single mutation among uncommon EGFR was exon 20 insertion (n = 6), followed by L861Q (n = 5) and G719X (n = 4). Thirteen (46%) patients had compound mutations. One hundred percent of male patients with G719X mutation were smokers. Sixteen of 28 patients were treated with EGFR-TKI. Most received first-generation EGFR-TKI, and 29% were treated with chemotherapy alone. The objective response rate was 37.5% in the EGFR-TKI group. Median progression-free survival (PFS) in the EGFR-TKI group was 10.2 months. Median PFS among the 8 patients in the chemotherapy group that received first-line platinum doublet was 6.5 months. Three-year overall survival (OS) among 28 patients was 34%. Three-year OS was significantly better in patients treated with EGFR-TKI. Conclusions Uncommon EGFR mutations was detected in 8.8% of EGFR-mutant NSCLC. Exon 20 insertion was the most common mutation, and 50% of patients had history of tobacco use. First- or second-generation EGFR-TKI demonstrated greater OS benefit than platinum-doublet chemotherapy among patients harboring uncommon EGFR-mutant NSCLC. Survival outcomes were comparable to those reported from previous large cohort studies.
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Affiliation(s)
- J Chantharasamee
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - N Poungvarin
- Clinical Molecular Pathology Laboratory, Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Danchaivijitr
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Techawatanawanna
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Zhang T, Wan B, Zhao Y, Li C, Liu H, Lv T, Zhan P, Song Y. Treatment of uncommon EGFR mutations in non-small cell lung cancer: new evidence and treatment. Transl Lung Cancer Res 2019; 8:302-316. [PMID: 31367543 PMCID: PMC6626855 DOI: 10.21037/tlcr.2019.04.12] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Sensitizing mutations in epidermal growth factor receptor (EGFR) are associated with positive responses to anti-EGFR-targeted therapy, leading to a new era of treatment for non-small cell lung cancer (NSCLC). Exon 19 deletions and exon 21 L858R substitutions are the most common mutations, accounting for approximately 90% mutations in NSCLC; these are termed classic mutations and result in high sensitivity to tyrosine kinase inhibitors (TKIs). Other EGFR mutations are termed uncommon EGFR mutations, of which G719X, S768I, L861Q, exon 20 insertions, and complex mutations are the most frequent. G719X, S768I, and L861Q are point mutations and those that exist with complex mutations are sensitive to first-generation TKIs. A prospective analysis demonstrated that afatinib, a second-generation TKI, led to a better prognosis in some patients with NSCLC compared to first-generation TKIs. Chemotherapy used to be the traditional choice for patients carrying exon 20 insertions; however, with the development of novel targeted drugs, the role of chemotherapy is changing. Tremendous progress has also been made in clinical trials on immunotherapy treatment of uncommon EGFR mutations. The treatment for patients with NSCLC harboring uncommon EGFR mutations remains a subject of debate and the sensitivity of uncommon EGFR mutations to TKIs is still unclear. Here, we summarized recent data in the literature and provide an overview of the clinical characteristics, incidence, and outcomes of patients harboring G719X, S768I, L861Q, exon 20 insertions, and complex mutations who were treated with TKIs, chemotherapy, or immunotherapy.
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Affiliation(s)
- Tianli Zhang
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing 210002, China
| | - Bing Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210002, China
| | - Yuan Zhao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chuling Li
- Department of Respiratory Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, China
| | - Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Respiratory Medicine, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, China
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14
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Martin J, Lehmann A, Klauschen F, Hummel M, Lenze D, Grohé C, Tessmer A, Gottschalk J, Schmidt B, Pau HW, Witt C, Moegling S, Kromminga R, Jöhrens K. Clinical Impact of Rare and Compound Mutations of Epidermal Growth Factor Receptor in Patients With Non-Small-Cell Lung Cancer. Clin Lung Cancer 2019; 20:350-362.e4. [PMID: 31175009 DOI: 10.1016/j.cllc.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/29/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard therapy of advanced non-small-cell lung cancer harboring an activating mutation in the epidermal growth factor receptor (EGFR) gene is treatment with tyrosine kinase inhibitors (TKI). However, for rare and compound mutations of the EGFR gene, the clinical evidence of TKI therapy is still unclear. PATIENTS AND METHODS A total of 2906 lung cancer samples were analyzed for EGFR mutations during routine analysis between 2010 and 2017. The samples have been investigated by Sanger sequencing and since 2014 by next-generation sequencing. RESULTS We detected EGFR mutations in 408 specimens (14%). Among these, we found 41 samples with rare and 22 with compound mutations. In these 63 samples, 56 different rare EGFR mutations occurred. Information about the clinical outcome was available for 37. Among those with rare mutations, only one patient harboring the mutation p.G874D had disease that responded to first-generation TKI therapy. In contrast, the disease of all patients with compound mutations responded to first- or second-generation TKI therapy. Furthermore, we collected data on clinical relevance regarding TKI therapy from different databases and from an additional literature search, and only found data for 36 of the 56 detected rare mutations. CONCLUSION Information about the clinical outcome of patients with rare and compound EGFR mutations remains limited. At present, second- and third-generation TKIs are available, which may represent new treatment strategies for these patients. Therefore, it is becoming increasingly important to maintain databases concerning rare EGFR mutations.
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Affiliation(s)
- Juliane Martin
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany; Provitro AG, Berlin, Germany.
| | - Annika Lehmann
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany
| | - Frederick Klauschen
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany
| | - Michael Hummel
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany
| | - Dido Lenze
- Institute of Pathology, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | - Joachim Gottschalk
- Department of Pathology and Neuropathology, Asklepios Klinik Nord, Hamburg, Germany
| | - Berndt Schmidt
- Lung Cancer Centrum, DRK-Kliniken Berlin Mitte, Berlin, Germany
| | - Hans-Wilhelm Pau
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Rostock, Germany
| | - Christian Witt
- Department of Pneumonology and Immunology, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | - Korinna Jöhrens
- Institute of Pathology, University Hospital Carl Gustav Carus, TU Dresden, Germany
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15
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First-generation EGFR tyrosine kinase inhibitor therapy in 106 patients with compound EGFR-mutated lung cancer: a single institution's clinical practice experience. Cancer Commun (Lond) 2018; 38:51. [PMID: 30055651 PMCID: PMC6064043 DOI: 10.1186/s40880-018-0321-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
Background The antitumour efficacy of tyrosine kinase inhibitors (TKIs) in lung cancer patients with compound epidermal growth factor receptor (EGFR) mutations has not been resolved. Our study summarizes a single institutional experience of first-generation TKI therapy for lung cancers with compound EGFR mutations. Methods A total of 106 consecutive patients with tumours bearing compound EGFR mutations were identified between January 2012 and May 2016; all patients received first-generation TKI therapy. Deletions in exon 19 and the L858R point mutation in exon 21 were considered common mutations; T790M was considered separately because of its association with TKIs resistances. Any other mutation was defined as a rare mutation. Patients were divided as follows: double common mutations (group A); common plus T790M mutations (group B); common plus rare mutations (group C); double rare mutations (group D); and rare plus T790M mutations (group E). A separate group of 115 consecutive patients with a single common mutation was created for comparative analysis (group F). Results The frequency of patients with compound EGFR was 2.9% (114/3925) and their response rate to first-generation TKIs was 50.9%, which was not significantly different from group F (67.0%, P = 0.088). The progression-free survival (PFS) of the 106 patients receiving TKI therapy was worse than that of group F (median, 9.1 vs. 13.0 months, respectively; P < 0.001). The PFS of the compound mutation group was shorter than that of the single common mutation group (median, 10.1 months in group A, P = 0.240; 9.1 months in group B, P < 0.001; 9.6 months in group C, P = 0.010; 6.5 months in group D, P = 0.048; 5.4 months in group E, P = 0.017). Patients with a co-occurring mutation in exon 20 (excluding T790M) exhibited significantly worse PFS than the patients with other compound mutations or with a single common mutation (median, 6.5 vs. 9.1 vs. 13.0 months, respectively, P = 0.002). Conclusions There was significant heterogeneity among the compound EGFR mutations and their response to first-generation TKIs. Individualized treatment in clinical practice should be considered for each case.
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16
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Chen Y, Gong J, Zhou H, Qu X, Teng Y, Liu Y, Jin B. Apatinib for EGFR-TKI and chemotherapy refractory in an advanced lung cancer patient: a case report. J Thorac Dis 2018; 10:E564-E569. [PMID: 30174935 DOI: 10.21037/jtd.2018.06.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ying Chen
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Junping Gong
- Department of Medical Oncology, Dalian University, Affiliated Xinhua Hospital, Dalian 116000, China
| | - Huiming Zhou
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Xiujuan Qu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Yuee Teng
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Yunpeng Liu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Bo Jin
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
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17
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Duan H, Peng Y, Cui H, Qiu Y, Li Q, Zhang J, Shen W, Sun C, Luo C. Effectiveness of afatinib after ineffectiveness of gefitinib in an advanced lung adenocarcinoma patient with a single EGFR exon 20 S768I mutation: a case report. Onco Targets Ther 2018; 11:2303-2309. [PMID: 29731638 PMCID: PMC5923252 DOI: 10.2147/ott.s151125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors have improved progression-free survival and overall survival in non-small-cell lung cancer (NSCLC) patients with sensitive mutations. However, response of uncommon mutation to epidermal growth factor receptor-tyrosine kinase inhibitors is still unclear. S768I is one of the uncommon mutations. A female patient with advanced NSCLC with a single S768I mutation achieved effectiveness from afatinib after showing no response to gefitinib. The patient had progression-free survival after taking afatinib for 6 months, and her follow-up is continuing. It suggests that afatinib may be a more effective treatment for NSCLC patients with a single S768I mutation, compared to first-generation tyrosine kinase inhibitors.
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Affiliation(s)
- Hua Duan
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanmei Peng
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Huijuan Cui
- Department of Oncology, China- Japan Friendship Hospital, Chaoyang, Beijing, China
| | - Yuqin Qiu
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiang Li
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingyi Zhang
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wen Shen
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chenyao Sun
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chufan Luo
- Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
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18
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Galli G, Corrao G, Imbimbo M, Proto C, Signorelli D, Ganzinelli M, Zilembo N, Vitali M, de Braud F, Garassino MC, Lo Russo G. Uncommon mutations in epidermal growth factor receptor and response to first and second generation tyrosine kinase inhibitors: A case series and literature review. Lung Cancer 2017; 115:135-142. [PMID: 29290256 DOI: 10.1016/j.lungcan.2017.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/27/2017] [Accepted: 12/03/2017] [Indexed: 01/05/2023]
Abstract
Epidermal growth factor receptor (EGFR) is the most common driver gene involved in non small cell lung cancer (NSCLC) growth, being found in approximately 10-15% of Caucasian and 40% of Asian patients. A wide variety of pathogenic mutations, deletions, insertions and duplications have been described in EGFR exons 18-21. The presence of the most common among them (e.g. exon 21 L851R and exon 19 deletions) is associated to response to first and second generation EGFR tyrosine kinase inhibitors (TKIs), which have demonstrated clear superiority over chemotherapy in terms of both progression free survival (PFS) and overall survival (OS) in all treatment lines. However, scarcity of data exists in literature about the response of rarer EGFR alterations to first and second generation TKIs, most works consisting in sporadic case reports and small case series. In this review we aim to discuss the available evidence about this topic, in order to derive suggestions for clinical practice. Furthermore, we report seven cases of patients with lung tumors harboring uncommon EGFR mutations, treated in our Institution with first or second generation TKIs.
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Affiliation(s)
- Giulia Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Giulia Corrao
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Martina Imbimbo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Monica Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Nicoletta Zilembo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Milena Vitali
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy; Medical Oncology Department, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Marina Chiara Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy
| | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale di Tumori, via G. Venezian 1, 20133, Milan, Italy.
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Shi J, Yang H, Jiang T, Li X, Zhao C, Zhang L, Zhao S, Liu X, Jia Y, Wang Y, Xi L, Zhang S, Su C, Ren S, Zhou C. Uncommon EGFR mutations in a cohort of Chinese NSCLC patients and outcomes of first-line EGFR-TKIs and platinum-based chemotherapy. Chin J Cancer Res 2017; 29:543-552. [PMID: 29353977 DOI: 10.21147/j.issn.1000-9604.2017.06.09] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Data on the clinical activity of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in patients with non-small-cell lung cancer (NSCLC) and uncommon EGFR mutations remain insufficient. This study aimed to investigate the effect of first-line EGFR-TKIs or platinum-based chemotherapy in NSCLC patients with uncommon EGFR mutations. Methods We retrospectively enrolled 504 patients with EGFR-mutant NSCLC. The clinical characteristics and treatment outcomes were collected and compared between patients with common and uncommon EGFR-mutant NSCLC. Results Seventy patients (13.9%) harboring uncommon EGFR mutations were included. Thirty of these patients received EGFR-TKIs and 40 received platinum-based chemotherapy as first-line therapy. The objective response rate (ORR) and median progression-free survival (mPFS) of patients treated with TKIs in the uncommon mutation group was significantly inferior to that in the common mutation group (ORR: 23.3% vs. 51.8%, P=0.003; mPFS: 7.1 vs. 10.9 months, P<0.001). In the uncommon group, mPFS was similar between first-line EGFR-TKIs treatment and platinum-based chemotherapy (7.1vs. 6.1 months, P=0.893). In patients with EGFR G719X or L861Q mutations, the mPFS was longer in the first-line EGFR-TKIs treatment group than in the chemotherapy group, but the difference was not statistically significant (G719X: 8.2 vs. 5.8 months, P=0.061; L861Q: 7.6 vs. 4.1 months, P=0.872). Multivariate analyses identified adenocarcinoma (P=0.003) as the independent predictive factor for PFS in patients with uncommon EGFR mutations who were treated with first-line EGFR-TKIs. Conclusions The current study demonstrated that the effect of first-line EGFR-TKIs was similar to that of platinum-based chemotherapy in patients with uncommon EGFR-mutant NSCLC. Adenocarcinoma was the independent predictive factor for PFS in uncommon EGFR-mutant NSCLC patients treated with first-line EGFR-TKIs.
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Affiliation(s)
- Jinpeng Shi
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Hui Yang
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Limin Zhang
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Sha Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiaozhen Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Yijun Jia
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Yan Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Lei Xi
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Shijia Zhang
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
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