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Li L, Huang S, Qin L, Yan N, Shen S, Li X. Successful treatment of lung adenocarcinoma complicated with a rare compound EGFR mutation L833V/H835L using aumolertinib: a case report and literature review. Front Pharmacol 2023; 14:1257592. [PMID: 37719840 PMCID: PMC10499621 DOI: 10.3389/fphar.2023.1257592] [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: 07/12/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background: The deletion of exon 19 and the Leu858Arg mutation of exon 21 are the most frequently observed mutations in the epidermal growth factor receptor (EGFR) gene, and patients with these mutations have shown significant benefits from EGFR-tyrosine kinase inhibitors (TKIs). However, there exists a small subgroup of patients with uncommon/rare mutations of EGFR, including compound mutations, which display a high degree of heterogeneity in terms of clinical features and variable sensitivities to EGFR-TKIs. The understanding of these uncommon mutations and their response to targeted therapy is still unclear and requires further investigation. Case presentation: We presented a case of a never-smoking patient with lung adenocarcinoma and brain metastasis. Initially, she received chemotherapy plus immune checkpoint inhibitor as first-line therapy as no EGFR mutations were detected by amplification-refractory mutation system-polymerase chain reaction. However, disease progressed rapidly. Subsequently, next-generation sequencing was carried out and revealed a rare compound mutation, L833V/H835L, in exon 21 of EGFR. As a result, she was switched to second-line therapy with the third-generation TKI aumolertinib, which demonstrated good efficacy. The patient was evaluated for a remarkable progression-free survival of 18 months and an overall survival of 29 months. Conclusion: The present study supports that aumolertinib might be a good treatment option for advanced NSCLC patients with EGFR L833V/H835L mutation, particularly in patients with brain metastasis. Furthermore, conducting a comprehensive screening for gene mutations is crucial in effectively identifying potential oncogenic driver mutations and guiding mutation-targeted therapy decisions in clinical practice.
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Affiliation(s)
- Linlin Li
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Siyuan Huang
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liying Qin
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Ningning Yan
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujing Shen
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingya Li
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Pretelli G, Spagnolo CC, Ciappina G, Santarpia M, Pasello G. Overview on Therapeutic Options in Uncommon EGFR Mutant Non-Small Cell Lung Cancer (NSCLC): New Lights for an Unmet Medical Need. Int J Mol Sci 2023; 24:ijms24108878. [PMID: 37240224 DOI: 10.3390/ijms24108878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The majority of epidermal growth factor receptor (EGFR) mutations (85-90%) are exon 19 deletions and L858R point mutations of exon 21, characterized by high sensitivity to EGFR-tyrosine kinase inhibitors (TKIs). Less is known about uncommon mutations (10-15% of EGFR mutations). The predominant mutation types in this category include exon 18 point mutations, exon 21 L861X, exon 20 insertions, and exon 20 S768I. This group shows a heterogeneous prevalence, partly due to different testing methods and to the presence of compound mutations, which in some cases can lead to shorter overall survival and different sensitivity to different TKIs compared to simple mutations. Additionally, EGFR-TKI sensitivity may also vary depending on the specific mutation and the tertiary structure of the protein. The best strategy remains uncertain, and the data of EGFR-TKIs efficacy are based on few prospective and some retrospective series. Newer investigational agents are still under study, and there are no other approved specific treatments targeting uncommon EGFR mutations. Defining the best treatment option for this patient population remains an unmet medical need. The objective of this review is to evaluate existing data on the outcomes, epidemiology, and clinical characteristics of lung cancer patients with rare EGFR mutations, with a focus on intracranial activity and response to immunotherapy.
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Affiliation(s)
- Giulia Pretelli
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Calogera Claudia Spagnolo
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy
| | - Giuliana Ciappina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, 98122 Messina, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
- Oncologia Medica 2, Istituto Oncologico Veneto, IRCCS, 35128 Padova, Italy
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Do KH, Le DT, Van Nguyen T, Do TA, Van Nguyen C. Prolonged response to first‐generation tyrosine kinase inhibitor in a metastatic non‐small cell lung cancer harbouring complex G719X and S768I mutations: A case report from Vietnam and literature review. Respirol Case Rep 2023; 11:e01131. [PMID: 37008893 PMCID: PMC10052446 DOI: 10.1002/rcr2.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023] Open
Abstract
A complex of G719X and S768I mutations is infrequently observed, constituting less than 0.3% of all EGFR‐positive non‐small cell lung cancer (NSCLC), and the response to first‐line TKIs is inconsistent in the literature. In this study, we report a patient with metastatic non‐small cell lung cancer carrying rare EGFR compound mutations of G719X and S768I who benefited from first‐line treatment with gefitinib in Vietnam. This patient had a prolonged response lasting over 44 months with first‐generation TKI. He continued to take gefitinib without experiencing serious adverse events. NSCLC with a rare complex of G719X and S768I mutation revealed a good response to gefitinib.
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Affiliation(s)
| | | | | | - Tu Anh Do
- National Cancer HospitalHanoiVietnam
| | - Chu Van Nguyen
- National Cancer HospitalHanoiVietnam
- Clinicopathology DepartmentHanoi Medical UniversityHanoiVietnam
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Ou L, Tang Y, Deng Y, Guo L, He Q, He T, Feng W. Case Report: Durable partial response to icotinib plus crizotinib in a lung adenocarcinoma patient with double uncommon EGFR G719D/L861Q mutations and an acquired novel CUX1-MET fusion. Front Oncol 2022; 12:911362. [PMID: 35957915 PMCID: PMC9360523 DOI: 10.3389/fonc.2022.911362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) patients harboring MET exon 14 skipping or high MET amplification display a high rate of response to MET inhibitors. However, MET fusions in NSCLC have rarely been revealed. In this report, a 63-year-old woman with lung adenocarcinoma (LADC), harboring EGFR exon 18 G719D and exon 21 L861Q mutations, received first-generation, EGFR-tyrosine kinase inhibitor (TKI) icotinib therapy. Next generation sequencing (NGS) results only displayed an EGFR T790M point mutation following icotinib resistance. Thus, the patient was treated with osimertinib and achieved a stable disease (SD). However, disease progressed after 15 months and a novel MET fusion (CUX1 exon14-MET exon15) in addition to EGFR G719D/L861Q mutations were simultaneously detected in a tissue biopsy sample. After more than nine months, the patient subsequently achieved a PR with the combination of icotinib and crizotinib. To our knowledge, this is the first case of LADC patient displaying the presence of EGFR double uncommon mutations and an acquired novel CUX1-MET fusion that has benefited from icotinib plus crizotinib treatment. Following nine months of PR with icotinib plus crizotinib, the patient, until the time of publication, is exhibiting stable disease. The results suggest that the CUX1-MET fusion may be sensitive to crizotinib, although previous reports indicated that some MET fusion cases did not respond to crizotinib. Given this disparity, distinguishing MET fusion partners when crizotinib is used in LADC treatment is also very important.
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Affiliation(s)
- Lanzi Ou
- Oncology, Guangdong Medical University, Zhanjiang, China
- Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
| | - Yicong Tang
- Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
| | - Yanming Deng
- Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
| | - Lijie Guo
- Medical Department Shanghai OrigiMed Co., Ltd, Shanghai, China
| | - Qingqing He
- Medical Department Shanghai OrigiMed Co., Ltd, Shanghai, China
| | - Tingting He
- Medical Department Shanghai OrigiMed Co., Ltd, Shanghai, China
| | - Weineng Feng
- Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
- *Correspondence: Weineng Feng,
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Shin KH, Lee SM, Park K, Choi H, Kim IS, Yoon SH, Oh SH. Effects of Different Centrifugation Protocols on the Detection of EGFR Mutations in Plasma Cell-Free DNA. Am J Clin Pathol 2022; 158:206-211. [PMID: 35285877 PMCID: PMC9350828 DOI: 10.1093/ajcp/aqac024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives Various preanalytical factors, including the collection tube, storage conditions, and centrifugation, affect the detection results of plasma cell-free DNA (cfDNA). We compared the effect of different centrifugation protocols on the detection of EGFR mutations in cfDNA. Methods We analyzed 117 plasma specimens from 110 patients with non–small cell lung cancer using the cobas EGFR Mutation Test v2 (Roche Diagnostics). We compared the identified EGFR mutations and semiquantitative index values from the 1- and 2-step centrifugation groups and confirmed the clinical impact of differences in the results after further high-speed centrifugation. Results We detected EGFR mutations in 44 (37.6%) and 47 (40.2%) samples that were centrifuged once and twice, respectively; the 2 groups showed an 89.7% (105/117) concordance and a strong correlation in their semiquantitative index values (r = 0.929). Among the 12 inconsistent result pairs, 9 samples of 2-step centrifugation (75%) were consistent with the results of a recent tissue biopsy. Conclusions Additional high-speed centrifugation has been shown to increase the sensitivity of EGFR mutation detection in a commercial in vitro diagnostic real-time polymerase chain reaction device and is an optimal preanalytical factor for detecting low-allele frequency gene mutations using low concentrations of cfDNA.
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Affiliation(s)
- Kyung-Hwa Shin
- Department of Laboratory Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea
- Department of Laboratory Medicine, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | | | - Hyunji Choi
- Department of Laboratory Medicine, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | - In-suk Kim
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea
- Department of Laboratory Medicine, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | - Seong Hoon Yoon
- Lung Cancer Clinic, Pulmonary Medicine Center, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seung Hwan Oh
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea
- Department of Laboratory Medicine, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
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Jiang K, Song N, Yang C, Tang S, Wu Z, Liu Z, Li Z. 3,4-Dihydroquinazolin-8-yl-3-phenylurea Derivatives: Synthesis, VEGFR-2 Kinase Inhibiting Activity, and Molecular Docking. RUSS J GEN CHEM+ 2021. [DOI: 10.1134/s107036322109022x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Xu Z, Qin F, Yuan L, Wei J, Sun Y, Qin J, Deng K, Zheng T, Li S. EGFR DNA Methylation Correlates With EGFR Expression, Immune Cell Infiltration, and Overall Survival in Lung Adenocarcinoma. Front Oncol 2021; 11:691915. [PMID: 34447695 PMCID: PMC8383738 DOI: 10.3389/fonc.2021.691915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background The epidermal growth factor receptor (EGFR) is a primary target of molecular targeted therapy for lung adenocarcinoma (LUAD). The mechanisms that lead to epigenetic abnormalities of EGFR in LUAD are still unclear. The purpose of our study was to evaluate the abnormal methylation of EGFR CpG sites as potential biomarkers for LUAD. Methods To assess the differentially methylation CpG sites of EGFR in LUAD, we used an integrative study of Illumina HumanMethylation450K and RNA-seq data from The Cancer Genome Atlas (TCGA). We evaluated and compared EGFR multiple-omics data to explore the role of CpG sites located in EGFR promoter regions and gene body regions and the association with transcripts, protein expression levels, mutations, and somatic copy number variation. We calculated the correlation coefficients between CpG sites of EGFR and immune infiltration fraction (by MCPcounter and ESTIMATE) and immune-related pathways in LUAD. Finally, we validated the differential methylation of clinically and prognostically relevant CpG sites using quantitative methylation-specific PCR (qMSP). Results We found that the methylation level of many EGFR CpGs in the promoter region was negatively correlated with the transcription level, protein expression, and SCNV, while the methylation at the gene body region was positively correlated with these features. The methylation level of EGFR CpGs in the promoter region was positively correlated with the level of immune infiltration and IFN-γ signature, while the opposite was found for methylation of the gene body region. The qMSP results showed that cg02316066 had a high methylation level, while cg02166842 had a low methylation level in LUAD. There was a high degree of co-methylation between cg02316066 and cg03046247. Conclusion Our data indicate that EGFR is an epigenetic regulator in LUAD acting through DNA methylation. Our research provides a theoretical basis for the further detection of EGFR DNA methylation as a predictive biomarker for LUAD survival and immunotherapy.
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Affiliation(s)
- Zhanyu Xu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fanglu Qin
- School of Information and Management, Guangxi Medical University, Nanning, China
| | - Liqiang Yuan
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiangbo Wei
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu Sun
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqi Qin
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Kun Deng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tiaozhan Zheng
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shikang Li
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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8
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Miyashita Y, Ko R, Shimada N, Mitsuishi Y, Miura K, Matsumoto N, Asao T, Shukuya T, Shibayama R, Koyama R, Takahashi K. Impact of the generation of EGFR-TKIs administered as prior therapy on the efficacy of osimertinib in patients with non-small cell lung cancer harboring EGFR T790M mutation. Thorac Cancer 2020; 12:329-338. [PMID: 33219754 PMCID: PMC7862784 DOI: 10.1111/1759-7714.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background There are few studies that directly compare the effects of osimertinib on patients with non‐small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) T790M mutation between the generation of prior EGFR tyrosine kinase inhibitors (TKIs). Methods We retrospectively reviewed clinical data from the medical records of consecutive patients with advanced NSCLC who had developed resistance to first‐ or second‐generation EGFR‐TKIs due to EGFR T790M mutation and were subsequently treated with osimertinib at Juntendo University Hospital. In patients with available tumor samples, target amplicon sequencing analyses were performed to explore the genetic biomarkers. Results A total of 38 patients with NSCLC harboring EGFR T790M mutation were treated with osimertinib. Eight patients were classified into group A (afatinib followed by osimertinib) and 30 patients were classified into group B (first‐generation EGFR‐TKI followed by osimertinib). Progression‐free survival (PFS) was significantly longer in group A than in group B (median PFS; not reached vs. 11.0 months, P = 0.018). Fourteen patients had available tissue samples collected before osimertinib treatment for target sequencing. In group A we found no additional mutations, other than EGFR T790M mutation. On the other hand, there were three samples in which other mutations emerged, in addition to EGFR T790M mutation, in group B. Conclusions PFS of osimertinib was significantly longer in patients with NSCLC harboring EGFR T790M mutation after treatment with afatinib than in patients after treatment with first generation EGFR‐TKIs. Additional mutations other than EGFR T790M may affect the efficacy of osimertinib treatment. Key points Significant findings of the study: PFS of osimertinib was significantly longer in patients with NSCLC harboring EGFR T790M mutation after treatment with afatinib than in patients after treatment with first generation EGFR‐TKIs. What this study adds: Additional mutations other than EGFR T790M may affect the efficacy of osimertinib treatment.
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Affiliation(s)
- Yosuke Miyashita
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoko Shimada
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoichiro Mitsuishi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keita Miura
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naohisa Matsumoto
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rina Shibayama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Koyama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Zhu Y, Tang J, Li X, Qin T, Wei Y. Durable Response to Osimertinib in a Chinese Patient with Metastatic Lung Adenocarcinoma Harboring a Rare EGFR L858R/D761Y Compound Mutation. Onco Targets Ther 2020; 13:10447-10451. [PMID: 33116624 PMCID: PMC7569175 DOI: 10.2147/ott.s268593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Uncommon mutations account for 10-15% of epidermal growth factor receptor (EGFR) mutations in patients with non-small-cell lung cancer (NSCLC). However, in spite of the wealth of knowledge of the clinical significance and tyrosine kinase inhibitor (TKI) sensitivity of these mutations, acquisition of deeper insights is limited by the paucity of case reports and cohort studies of the exceptionally rare mutations, including compound mutations. In the present case, we describe the clinical efficacy of icotinib and osimertinib in a metastatic lung adenocarcinoma patient carrying a highly uncommon EGFR L858R/D761Y compound mutation. The progression-free survival (PFS) with osimertinib treatment was much longer than that with icotinib (19 mo vs 8.2 mo), and the overall survival (OS) has currently exceeded three years. To the best of our knowledge, this is the first report of durable osimertinib response in an NSCLC patient with a rare EGFR L858R/D761Y mutation.
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Affiliation(s)
- Yajie Zhu
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People's Republic of China
| | - Jianning Tang
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People's Republic of China
| | - Xin Li
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People's Republic of China
| | - Tian Qin
- Burning Rock Biotech, Guangzhou 510300, People's Republic of China
| | - Yang Wei
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People's Republic of China
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Long X, Qin T, Lin J. Great Efficacy of Afatinib in a Patient with Lung Adenocarcinoma Harboring EGFR L833V/H835L Mutations: A Case Report. Onco Targets Ther 2020; 13:10689-10692. [PMID: 33116645 PMCID: PMC7585793 DOI: 10.2147/ott.s260157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
Uncommon mutations account for 10-15% of epidermal growth factor receptor (EGFR) mutations in patients with non-small-cell lung cancer (NSCLC). Most of them are proved to be sensitive or resistant to EGFR-tyrosine kinase inhibitors (TKIs). However, there is insufficient evidence for other less common types of EGFR mutations, such as complex mutations. Here, we present a 65-year-old never-smoking male who was diagnosed with stage IV lung adenocarcinoma. A rare L833V/H835L complex mutation in exon 21 of EGFR was detected in plasma and pleural effusion by next generation sequencing (NGS). Afatinib was used as first-line therapy and showed very good efficacy. To date, the patient is still benefited from afatinib treatment for a total of 10 months, with no signs of disease progression. Our case suggests that a comprehensive screening for EGFR mutations should be conducted before treatment in clinical practice, and afatinib could be a first-line treatment option in NSCLC patients harboring H833V/H835L mutations.
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Affiliation(s)
- Xiang Long
- Department of Respiratory Medicine, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Tian Qin
- Burning Rock Biotech, Guangzhou, 510300, China
| | - Junhong Lin
- Department of Respiratory Medicine, Huizhou Municipal Central Hospital, Huizhou, 516001, China
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Suda K, Sakai K, Obata K, Ohara S, Fujino T, Koga T, Hamada A, Soh J, Nishio K, Mitsudomi T. Inter- and Intratumor Heterogeneity of EGFR Compound Mutations in Non-Small Cell Lung Cancers: Analysis of Five Cases. Clin Lung Cancer 2020; 22:e141-e145. [PMID: 33051123 DOI: 10.1016/j.cllc.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several clinical and preclinical studies suggest that non-small cell lung cancers (NSCLCs) with EGFR compound mutations were associated with lower efficacies of first-generation EGFR inhibitors than tumors with single EGFR mutation. Some researchers hypothesize that EGFR mutation status is heterogeneous in such tumors and that second-generation EGFR inhibitors may eliminate cancer cells with uncommon EGFR mutations from tumors with EGFR compound mutations. However, this hypothesis is currently unproven; therefore, we performed the current study to determine if tumor cells with EGFR compound mutations are present in heterogeneous or homogeneous manners. PATIENTS AND METHODS Multiregion analysis was performed for surgically resected primary NSCLC tumors with EGFR compound mutations to examine the intratumor heterogeneity of EGFR compound mutations. In addition, we evaluated the intertumor heterogeneity of EGFR compound mutations using 2 pleural disseminations obtained from a patient with NSCLC at exploratory thoracotomy and 9 primary or metastatic lesions obtained from 2 autopsied NSCLC patients. Digital polymerase chain reaction, target sequencing, or direct sequencing were used to detect EGFR mutations. RESULTS This study included 5 NSCLC cases; their compound mutations were L858R+S768I, G719X+S768I, G719A+R776H, L858R+E709G, and L858R+I759M. Noncancerous pulmonary tissues from each patient did not harbor EGFR mutations, which revealed that all mutations were somatic. We did not detect any intra- or intertumor heterogeneity in these EGFR compound mutations. CONCLUSION No intra- or intertumor heterogeneity was observed for EGFR compound mutations. Our results indicate that both EGFR mutations were truncal and selective elimination of cancer cells with uncommon EGFR mutations is unrealistic.
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Affiliation(s)
- Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Keiko Obata
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shuta Ohara
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Toshio Fujino
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takamasa Koga
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akira Hamada
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Junichi Soh
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
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Liu H, Zhang B, Sun Z. Spectrum of EGFR aberrations and potential clinical implications: insights from integrative pan-cancer analysis. Cancer Commun (Lond) 2020; 40:43-59. [PMID: 32067422 PMCID: PMC7163653 DOI: 10.1002/cac2.12005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/31/2019] [Indexed: 12/18/2022] Open
Abstract
Background Human epidermal growth factor receptor (EGFR) is an oncogenic gene and one of top targets of precision therapy in lung cancer with EGFR mutations. Although there are many reports for some individual cancers, comprehensive profiling of EGFR mutations, overexpression, amplification, DNA methylation, and their clinical associations across many different cancers simultaneously was not available. This study aimed to fill the gap and provide insights to the alteration spectrum of EGFR and its therapeutic and prognostic implications. Methods The Cancer Genome Atlas (TCGA) datasets for 32 cancer types involving 11,314 patients were analyzed for alterations (mutations and amplification/deletion), abnormal expression and DNA methylation in EGFR gene. Mutation frequency, genomic location distribution, functional impact, and clinical targeted therapy implication were compared among different cancer types, and their associations with patient survival were analyzed. Results EGFR alteration frequency, mutation sites across functional domains, amplification, overexpression, and DNA methylation patterns differed greatly among different cancer types. The overall mutation frequency in all cancers combined was relatively low. Targetable mutations, mainly in lung cancer, were primarily found in the Pkinase_Tyr domain. Glioblastoma multiforme had the highest rate of alterations, but it was dominated by gene amplification and most mutations were in the Furin‐like domain where targeted therapy was less effective. Low‐grade glioma often had gene amplification and increased EGFR expression which was associated with poor outcome. Colon and pancreatic adenocarcinoma had very few EGFR mutations; however, high EGFR expression was significantly associated with short patient survival. Squamous cell carcinoma regardless of their sites (the head and neck, lung, or esophagus) exhibited similar characteristics with an alteration frequency of about 5.0%, was dominated by gene amplification, and had increased EGFR expression generally associated with short patient survival. DNA methylation was highly associated with EGFR expression and patient outcomes in some cancers. Conclusions EGFR aberration type, frequency, distribution in functional domains, and expression vary from cancer to cancer. While mutations in the Pkinase_Tyr domain are more important for treatment selection, increased expression from amplification or deregulation affects more tumor types and leads to worse outcome, which calls for new treatment strategies for these EGFR‐driven tumors.
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Affiliation(s)
- Haijing Liu
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, P. R. China.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Bo Zhang
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, P. R. China
| | - Zhifu Sun
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
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13
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Zhang W, Li F, Gao W. New data highlighting the efficacy and safety outcomes of third-generation EGFR-TKI in NSCLC patients with rare EGFR mutations. Thorac Cancer 2020; 11:495-497. [PMID: 31989783 DOI: 10.1111/1759-7714.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Weisan Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.,Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenyuan Gao
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
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14
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Weng CF, Chen PJ, Tseng AH, Huang SH, Lee HHC. Unusual synchronous double primary treatment-naïve lung adenocarcinoma harboring T790M and L858R mutations in early-stage lung cancer. World J Surg Oncol 2019; 17:148. [PMID: 31426797 PMCID: PMC6701136 DOI: 10.1186/s12957-019-1688-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background Concurrent mutations of synchronous multiple primary non-small cell lung cancer (SMPNSCLC) is rare, and only a few cases have been reported. Herein, we present a case of early-stage SMPNSCLC with T790M and L858R mutations. Case presentation A 68-year-old male patient presented to the Thoracic Surgery Department due to a tumor in the right lower lung. The tumor was detected more than 5 years previously during a health examination; however, the patient ignored the problem because the clinician at that time stated that the lesion was highly likely to be benign. Chest computed topography (CT) was ordered and the images showed a well-defined tumor in the right lower lung and a faint nodular lesion over the left lower lung field. A CT-guided biopsy results showed the presence of atypical cells and positive staining of TTF-1 and CK7. Surgical intervention was performed. The right- and left-sided tumors disclosed micropapillary predominant adenocarcinoma and acinar-predominant adenocarcinoma, respectively. Both tumors were positive for TTF-1 but negative for ALK and p40. Real-time PCR analysis showed that the right-sided tumor had an epidermal growth factor receptor (EGFR) mutation presenting as point mutation T790M in exon 20, while the left-sided tumor had a point mutation L858R in exon 21 of EGFR. Conclusions Our patient’s case suggests that tumors resembling a benign pattern with central calcification may be misdiagnosed. Thus, early screening for lung cancer is important, and intensive efforts to make a diagnosis through surgical resection or biopsies to allow for tailored optimal treatment may be preferential for the best patient outcomes.
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Affiliation(s)
- Ching-Fu Weng
- Department of Thoracic Medicine, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - Po-Ju Chen
- Department of Thoracic Surgery, Xizhi Cathay General Hospital, New Taipei, Taiwan
| | - Ailun Heather Tseng
- Systems Biology and Bioinformatics, National Central University, Taoyuan, Taiwan
| | - Shih-Hung Huang
- Department of Pathology, Cathay General Hospital, No. 280, Sec. 4, Ren'ai Rd., Da'an Dist., 106, Taipei, Taiwan.
| | - Henry Hsin-Chung Lee
- Department of Surgery, Hsinchu Cathay General Hospital, No. 678, Sec. 2, Zhonghua Rd., East Dist., Hsinchu City, 300, Taiwan.
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15
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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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16
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Falla-Martinez JC, Espinosa D, Baena JC, Rodriguez LX, Sua LF, Zambrano AR. An endothelial growth factor receptor compound mutation of T790M substitution with exon 19 deletion in a previously untreated patient: a case report. J Med Case Rep 2019; 13:144. [PMID: 31088573 PMCID: PMC6518648 DOI: 10.1186/s13256-019-2075-y] [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: 08/03/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endothelial growth factor receptor (EGFR) mutations are an essential driver of personalized therapy for patients with lung cancer and are detected in approximately 15% of Caucasian and 50% of Asian patients. EGFR tyrosine kinase inhibitors have been developed and used for this set of patients. T790M mutation in exon 20 is usually associated with secondary resistance to EGFR tyrosine kinase inhibitors therapy but is also present in treatment-naïve patients. The frequency for baseline T790M mutation varies from 4 to 35% according to the detection method used. Newer techniques have yielded higher rates, but concerns about false-positive results have been raised. Compound mutations account for 4-14% of all EGFR-mutated tumors, with no studies yet to provide a frequency rate for T790M + 19 deletion association due to the small number of cases. However, there are reports that pretreatment T790M + L858R association is significantly more frequent compared to T790M + exon 19 deletion mutations. Diagnostic challenges, current knowledge on the subject, and therapeutic decisions are discussed. CASE PRESENTATION We present the case of a 43-year-old Hispanic woman, a treatment-naïve patient, with metastasized lung cancer adenocarcinoma harboring a T790M deletion along with the classic 19 mutation. The initial symptoms were monoparesis of her left leg, associated with hyperreflexia, and hypoesthesia. In the absence of third-generation tyrosine kinase inhibitors, a platinum-based therapy was initiated with no response and she died 4 months after diagnosis. CONCLUSIONS Osimertinib seems to be a suitable therapy for treatment-naïve patients with sensitizing and resistant compound EGFR mutations. More studies regarding the clinical characteristics of these patients and the appropriate management of this condition are needed to provide the highest standard of care.
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Affiliation(s)
- Juan C Falla-Martinez
- Hematology-Oncology department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Fundacion Valle del Lili, Cali, Colombia
| | - Daniela Espinosa
- Internal Medicine department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Juan C Baena
- Hematology-Oncology department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Fundacion Valle del Lili, Cali, Colombia
| | - Lisa X Rodriguez
- Human Genetics department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Luz F Sua
- Pathology department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Cali, Colombia
| | - Angela R Zambrano
- Hematology-Oncology department, Fundacion Valle del Lili, Carrera 98 No. 18-49, Fundacion Valle del Lili, Cali, Colombia.
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17
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Otoukesh B, Boddouhi B, Moghtadaei M, Kaghazian P, Kaghazian M. Novel molecular insights and new therapeutic strategies in osteosarcoma. Cancer Cell Int 2018; 18:158. [PMID: 30349420 PMCID: PMC6192346 DOI: 10.1186/s12935-018-0654-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Osteosarcoma (OS) is one of the most prevalent malignant cancers with lower survival and poor overall prognosis mainly in children and adolescents. Identifying the molecular mechanisms and OS stem cells (OSCs) as new concepts involved in disease pathogenesis and progression may potentially lead to new therapeutic targets. Therefore, therapeutic targeting of OSCs can be one of the most important and effective strategies for the treatment of OS. This review describes the new molecular targets of OS as well as novel therapeutic approaches in the design of future investigations and treatment.
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Affiliation(s)
- Babak Otoukesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, 1445613131 Iran
| | - Bahram Boddouhi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, 1445613131 Iran
| | - Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, 1445613131 Iran
| | - Peyman Kaghazian
- Department of Orthopedic and Traumatology, Universitätsklinikum Bonn, Bonn, Germany
| | - Maria Kaghazian
- Department of Biology, Jundishapur University of Medical Sciences, Ahvaz, Iran
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