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Heigener DF, Schumann C, Sebastian M, Sadjadian P, Stehle I, Märten A, Lüers A, Griesinger F, Scheffler M. Afatinib in Non-Small Cell Lung Cancer Harboring Uncommon EGFR Mutations Pretreated With Reversible EGFR Inhibitors. Oncologist 2015; 20:1167-74. [PMID: 26354527 DOI: 10.1634/theoncologist.2015-0073] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/15/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Afatinib, an irreversible ErbB family blocker, is approved for treatment of patients with previously untreated non-small cell lung cancer (NSCLC) harboring activating epidermal growth factor receptor (EGFR) mutations. Efficacy of afatinib in EGFR tyrosine kinase inhibitor-naïve (TKI-naïve) patients with uncommon EGFR mutations (other than exon 19 deletions or exon 21 point mutations) has been reported; however, efficacy in TKI-pretreated patients with uncommon EGFR mutations is unknown. MATERIALS AND METHODS In the afatinib compassionate use program (CUP), patients with advanced or metastatic, histologically confirmed NSCLC progressing after at least one line of chemotherapy and one line of EGFR-TKI treatment were enrolled. Demographic data, mutation type, response rates, time to treatment failure (TTF), and safety in patients harboring uncommon EGFR mutations were reported. RESULTS In 60 patients (63% female, median age 63 years [range: 30-84 years]), a total of 66 uncommon EGFR mutations including 30 T790M mutations were reported (18.4% and 11%, respectively, of known EGFR mutations within the CUP). Most patients (67%) received afatinib as third- or fourth-line treatment. Median TTF was 3.8 months (range: 0.2 to >24.6 months; p = .244) in patients with uncommon mutations compared with 5.1 months (range: 0.1 to >21.1 months) in patients with common mutations (n = 165). Pronounced activity was observed with E709X mutations (TTF >12 months). No new safety signals were detected. CONCLUSION Afatinib is clinically active and well tolerated in many TKI-pretreated NSCLC patients harboring uncommon EGFR mutations. Compared with results reported in TKI-naïve patients, activity was also indicated in patients with T790M and exon 20 insertion mutations.
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Affiliation(s)
- David F Heigener
- LungenClinic Grosshandsdorf, Thoracic Oncology, German Center for Lung Research, Grosshansdorf, Germany
| | - Christian Schumann
- Clinic for Pulmonary, Thoracic Oncology, Sleep and Respiratory Critical Care, Kempten-Oberallgaeu Hospitals GmbH, Immenstadt, Germany
| | - Martin Sebastian
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Parvis Sadjadian
- Clinic for Hematology, Oncology and Palliative Medicine, Minden, Germany
| | - Ingo Stehle
- Department of Internal Medicine V, University Hospital of the Saarland, Homburg, Germany
| | - Angela Märten
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Anne Lüers
- Department Hematology and Oncology, Pius-Hospital Oldenburg, University Department of Internal Medicine-Oncology, Medical Campus, University of Oldenburg, Oldenburg, Germany
| | - Frank Griesinger
- Department Hematology and Oncology, Pius-Hospital Oldenburg, University Department of Internal Medicine-Oncology, Medical Campus, University of Oldenburg, Oldenburg, Germany
| | - Matthias Scheffler
- Department of Internal Medicine I, Center for Integrated Oncology, University of Cologne, Cologne, Germany
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Niederst MJ, Sequist LV, Poirier JT, Mermel CH, Lockerman EL, Garcia AR, Katayama R, Costa C, Ross KN, Moran T, Howe E, Fulton LE, Mulvey HE, Bernardo LA, Mohamoud F, Miyoshi N, VanderLaan PA, Costa DB, Jänne PA, Borger DR, Ramaswamy S, Shioda T, Iafrate AJ, Getz G, Rudin CM, Mino-Kenudson M, Engelman JA. RB loss in resistant EGFR mutant lung adenocarcinomas that transform to small-cell lung cancer. Nat Commun 2015; 6:6377. [PMID: 25758528 PMCID: PMC4357281 DOI: 10.1038/ncomms7377] [Citation(s) in RCA: 458] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 01/21/2015] [Indexed: 01/20/2023] Open
Abstract
Tyrosine kinase inhibitors are effective treatments for non-small-cell lung cancers (NSCLCs) with epidermal growth factor receptor (EGFR) mutations. However, relapse typically occurs after an average of 1 year of continuous treatment. A fundamental histological transformation from NSCLC to small-cell lung cancer (SCLC) is observed in a subset of the resistant cancers, but the molecular changes associated with this transformation remain unknown. Analysis of tumour samples and cell lines derived from resistant EGFR mutant patients revealed that Retinoblastoma (RB) is lost in 100% of these SCLC transformed cases, but rarely in those that remain NSCLC. Further, increased neuroendocrine marker and decreased EGFR expression as well as greater sensitivity to BCL2 family inhibition are observed in resistant SCLC transformed cancers compared with resistant NSCLCs. Together, these findings suggest that this subset of resistant cancers ultimately adopt many of the molecular and phenotypic characteristics of classical SCLC. Resistance to tyrosine kinase inhibitors occurs in treatments of non-small-cell lung cancers (NSCLCs) with EGFR mutations but the mechanisms underlying this acquired resistance are unknown. Here the authors examine the molecular changes that occur in resistant cancers that transition from NSCLC to small-cell lung cancer phenotype and implicate loss of retinoblastoma in this process.
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Affiliation(s)
- Matthew J Niederst
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Lecia V Sequist
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - John T Poirier
- Memorial Sloan Kettering Cancer Center, Thoracic Oncology Service, 1275 York Avenue, New York, New York 10065, USA
| | - Craig H Mermel
- 1] Broad Institute of MIT and Harvard, Cancer Genome Comparative Analysis Group, 415 Main Street, Cambridge, Massachusetts 02142, USA [2] Department of Pathology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Elizabeth L Lockerman
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Angel R Garcia
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Ryohei Katayama
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Carlotta Costa
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Kenneth N Ross
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Teresa Moran
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Emily Howe
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Linnea E Fulton
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Hillary E Mulvey
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Lindsay A Bernardo
- 1] Department of Pathology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Farhiya Mohamoud
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Norikatsu Miyoshi
- 1] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA [2] Molecular Profiling Laboratory, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Daniel B Costa
- Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02115, USA
| | - Pasi A Jänne
- 1] Department of Medical Oncology, Belfer Institute of Applied Science, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA [2] Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115, USA
| | - Darrell R Borger
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Sridhar Ramaswamy
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA [3] Broad Institute of MIT and Harvard, Cancer Genome Comparative Analysis Group, 415 Main Street, Cambridge, Massachusetts 02142, USA
| | - Toshi Shioda
- 1] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA [2] Molecular Profiling Laboratory, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Anthony J Iafrate
- 1] Department of Pathology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Gad Getz
- 1] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA [2] Broad Institute of MIT and Harvard, Cancer Genome Comparative Analysis Group, 415 Main Street, Cambridge, Massachusetts 02142, USA [3] Department of Pathology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Charles M Rudin
- Memorial Sloan Kettering Cancer Center, Thoracic Oncology Service, 1275 York Avenue, New York, New York 10065, USA
| | - Mari Mino-Kenudson
- 1] Department of Pathology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
| | - Jeffrey A Engelman
- 1] Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA [2] Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115, USA
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