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Wagener-Ryczek S, Heydt C, Süptitz J, Michels S, Falk M, Alidousty C, Fassunke J, Ihle MA, Tiemann M, Heukamp L, Wolf J, Büttner R, Merkelbach-Bruse S. Mutational spectrum of acquired resistance to reversible versus irreversible EGFR tyrosine kinase inhibitors. BMC Cancer 2020; 20:408. [PMID: 32397977 PMCID: PMC7216404 DOI: 10.1186/s12885-020-06920-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
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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Affiliation(s)
- Svenja Wagener-Ryczek
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Carina Heydt
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Juliane Süptitz
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Michels
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Markus Falk
- Insitute for Haematopathology, Hamburg, Hamburg, Germany
| | - Christina Alidousty
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Jana Fassunke
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Michaela Angelika Ihle
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Markus Tiemann
- Insitute for Haematopathology, Hamburg, Hamburg, Germany
| | - Lukas Heukamp
- Insitute for Haematopathology, Hamburg, Hamburg, Germany.,NEO New Oncology GmbH, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany
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