1
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He J, Huang Z, Han L, Gong Y, Xie C. Mechanisms and management of 3rd‑generation EGFR‑TKI resistance in advanced non‑small cell lung cancer (Review). Int J Oncol 2021; 59:90. [PMID: 34558640 PMCID: PMC8562388 DOI: 10.3892/ijo.2021.5270] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/17/2022] Open
Abstract
Targeted therapy with epidermal growth factor receptor (EGFR)‑tyrosine kinase inhibitors (TKIs) is a standard modality of the 1st‑line treatments for patients with advanced EGFR‑mutated non‑small cell lung cancer (NSCLC), and substantially improves their prognosis. However, EGFR T790M mutation is the primary mechanism of 1st‑ and 2nd‑generation EGFR‑TKI resistance. Osimertinib is a representative of the 3rd‑generation EGFR‑TKIs that target T790M mutation, and has satisfactory efficacy in the treatment of T790M‑positive NSCLC with disease progression following use of 1st‑ or 2nd‑generation EGFR‑TKIs. Other 3rd‑generation EGFR‑TKIs, such as abivertinib, rociletinib, nazartinib, olmutinib and alflutinib, are also at various stages of development. However, the occurrence of acquired resistance is inevitable, and the mechanisms of 3rd‑generation EGFR‑TKI resistance are complex and incompletely understood. Genomic studies in tissue and liquid biopsies of resistant patients reveal multiple candidate pathways. The present review summarizes the recent findings in mechanisms of resistance to 3rd‑generation EGFR‑TKIs in advanced NSCLC, and provides possible strategies to overcome this resistance. The mechanisms of acquired resistance mainly include an altered EGFR signaling pathway (EGFR tertiary mutations and amplification), activation of aberrant bypassing pathways (hepatocyte growth factor receptor amplification, human epidermal growth factor receptor 2 amplification and aberrant insulin‑like growth factor 1 receptor activation), downstream pathway activation (RAS/RAF/MEK/ERK and PI3K/AKT/mTOR) and histological/phenotypic transformations (SCLC transformation and epithelial‑mesenchymal transition). The combination of targeted therapies is a promising strategy to treat osimertinib‑resistant patients, and multiple clinical studies on novel combined therapies are ongoing.
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Affiliation(s)
- Jingyi He
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Zhengrong Huang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Linzhi Han
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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2
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Tripathi SK, Pandey K, Rengasamy KRR, Biswal BK. Recent updates on the resistance mechanisms to epidermal growth factor receptor tyrosine kinase inhibitors and resistance reversion strategies in lung cancer. Med Res Rev 2020; 40:2132-2176. [PMID: 32596830 DOI: 10.1002/med.21700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Abstract
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have led to a substantial improvement in the prognosis of lung cancer patients by explicitly targeting the activating mutations within the EGFR. Initially, patients harboring tumors with EGFR mutations show progression-free survival and improvement in the response rates toward all-generation EGFR-TKIs; however, these agents fail to deliver the intended results in the long-term due to drug resistance. Therefore, it is necessary to recognize specific cardinal mechanisms that regulate the resistance phenomenon. Understanding the intricate mechanisms underlying EGFR-TKIs resistance in lung cancer could provide cognizance for more advanced targeted therapeutics. The present review features insights into current updates on the discrete mechanisms, including secondary or tertiary mutations, parallel and downstream signaling pathways, acquiring an epithelial-to-mesenchymal transition (EMT) signature, microRNAs (miRNAs), and epigenetic alterations, which lead to intrinsic and acquired resistance against EGFR-TKIs in lung cancer. In addition, this paper also reviews current possible strategies to overcome this issue using combination treatment of recently developed MET inhibitors, allosteric inhibitors or immunotherapies, transformation of EMT, targeting miRNAs, and epigenetic alterations in intrinsic and acquired EGFR-TKIs resistant lung cancer. In conclusion, multiple factors are responsible for intrinsic and acquired resistance to EGFR-TKIs and understanding of the detailed molecular mechanisms, and recent advancements in pharmacological studies are needed to develop new strategies to overcome intrinsic and acquired EGFR-TKIs resistance in lung cancer.
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Affiliation(s)
- Surya K Tripathi
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kamal Pandey
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kannan R R Rengasamy
- Department of Bioresources and Food Science, Konkuk University, Seoul, South Korea
| | - Bijesh K Biswal
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
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3
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Lategahn J, Keul M, Klövekorn P, Tumbrink HL, Niggenaber J, Müller MP, Hodson L, Flaßhoff M, Hardick J, Grabe T, Engel J, Schultz-Fademrecht C, Baumann M, Ketzer J, Mühlenberg T, Hiller W, Günther G, Unger A, Müller H, Heimsoeth A, Golz C, Blank-Landeshammer B, Kollipara L, Zahedi RP, Strohmann C, Hengstler JG, van Otterlo WAL, Bauer S, Rauh D. Inhibition of osimertinib-resistant epidermal growth factor receptor EGFR-T790M/C797S. Chem Sci 2019; 10:10789-10801. [PMID: 31857889 PMCID: PMC6886544 DOI: 10.1039/c9sc03445e] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022] Open
Abstract
We present inhibitors of drug resistant mutants of EGFR including T790M and C797S. In addition, we present the first X-ray crystal structures of covalent inhibitors in complex with C797S-mutated EGFR to gain insight into their binding mode.
Precision medicine has revolutionized the treatment of patients in EGFR driven non-small cell lung cancer (NSCLC). Targeted drugs show high response rates in genetically defined subsets of cancer patients and markedly increase their progression-free survival as compared to conventional chemotherapy. However, recurrent acquired drug resistance limits the success of targeted drugs in long-term treatment and requires the constant development of novel efficient inhibitors of drug resistant cancer subtypes. Herein, we present covalent inhibitors of the drug resistant gatekeeper mutant EGFR-L858R/T790M based on the pyrrolopyrimidine scaffold. Biochemical and cellular characterization, as well as kinase selectivity profiling and western blot analysis, substantiate our approach. Moreover, the developed compounds possess high activity against multi drug resistant EGFR-L858R/T790M/C797S in biochemical assays due to their highly reversible binding character, that was revealed by characterization of the binding kinetics. In addition, we present the first X-ray crystal structures of covalent inhibitors in complex with C797S-mutated EGFR which provide detailed insight into their binding mode.
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Affiliation(s)
- Jonas Lategahn
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Marina Keul
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Philip Klövekorn
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Hannah L Tumbrink
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Janina Niggenaber
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Matthias P Müller
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Luke Hodson
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Department of Chemistry and Polymer Science , Stellenbosch University , Private Bag X1 , Matieland 7602 , South Africa
| | - Maren Flaßhoff
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Julia Hardick
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Tobias Grabe
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Julian Engel
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | | | - Matthias Baumann
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Julia Ketzer
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Thomas Mühlenberg
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Wolf Hiller
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Georgia Günther
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) , TU Dortmund University , Ardeystrasse 67 , 44139 Dortmund , Germany
| | - Anke Unger
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Heiko Müller
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Alena Heimsoeth
- Molecular Pathology , Institute of Pathology , University Hospital of Cologne , Kerpener Strasse 62 , 50937 Cologne , Germany.,Department of Translational Genomics , Center of Integrated Oncology Cologne-Bonn , Medical Faculty , University of Cologne , Weyertal 115b , 50931 Cologne , Germany
| | - Christopher Golz
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Bernhard Blank-Landeshammer
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany
| | - Laxmikanth Kollipara
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany
| | - René P Zahedi
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany.,Segal Cancer Proteomics Centre , Lady Davis Institute , Jewish General Hospital , McGill University , 3755 Côte Ste-Catherine Road , Montreal , Quebec H3T 1E2 , Canada
| | - Carsten Strohmann
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) , TU Dortmund University , Ardeystrasse 67 , 44139 Dortmund , Germany
| | - Willem A L van Otterlo
- Department of Chemistry and Polymer Science , Stellenbosch University , Private Bag X1 , Matieland 7602 , South Africa
| | - Sebastian Bauer
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Daniel Rauh
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
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4
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Choo JRE, Tan CS, Soo RA. Treatment of EGFR T790M-Positive Non-Small Cell Lung Cancer. Target Oncol 2019; 13:141-156. [PMID: 29423594 DOI: 10.1007/s11523-018-0554-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The treatment of lung cancer has changed dramatically with the development of tyrosine kinase inhibitors (TKIs) that target sensitizing somatic mutations of the epidermal growth factor receptor (EGFR). Despite remarkable initial responses, patients eventually develop progressive disease, with the most common cause of resistance to first-line EGFR TKIs being the acquired T790M mutation. Various third-generation EGFR TKIs have been developed to specifically target this acquired mutation, of which osimertinib is currently the only approved agent. In addition, the eagerly anticipated data from the FLAURA study recently found improved efficacy with increased progression-free survival (PFS) with osimertinib compared to standard of care first-generation EGFR TKIs in the first-line setting. Of note, osimertinib has also demonstrated promising efficacy in patients with known brain metastases. However, as patients invariably develop resistance during treatment with osimertinib, most commonly with the development of triple mutated EGFR (sensitizing mutations/T790M/C797S), which is resistant to all existing EGFR TKIs, efforts are currently ongoing to develop new strategies or novel compounds to specifically target this resistance mechanism.
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Affiliation(s)
- Joan Rou-En Choo
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Chee-Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,School of Surgery, The University of Western Australia, Perth, Australia.
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5
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Muluhngwi P, Valdes Jr R, Fernandez-Botran R, Burton E, Williams B, Linder MW. Cell-free DNA diagnostics: current and emerging applications in oncology. Pharmacogenomics 2019; 20:357-380. [DOI: 10.2217/pgs-2018-0174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Liquid biopsy is a noninvasive dynamic approach for monitoring disease over time. It offers advantages including limited risks of blood sampling, opportunity for more frequent sampling, lower costs and theoretically non-biased sampling compared with tissue biopsy. There is a high degree of concordance between circulating tumor DNA mutations versus primary tumor mutations. Remote sampling of circulating tumor DNA can serve as viable option in clinical diagnostics. Here, we discuss the progress toward broad adoption of liquid biopsy as a diagnostic tool and discuss knowledge gaps that remain to be addressed.
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Affiliation(s)
- Penn Muluhngwi
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Roland Valdes Jr
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Rafael Fernandez-Botran
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Eric Burton
- Department of Neurology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Brian Williams
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Mark W Linder
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
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6
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Goldman JW, Karlovich C, Sequist LV, Melnikova V, Franovic A, Gadgeel SM, Reckamp KL, Camidge DR, Pérol M, Ou SHI, Liu SV, Yu HA, Soria JC, Socinski MA, Mekhail TM, Solomon BJ, Natale RB, Otterson GA, Papadimitrakopoulou V, Langer CJ, Neal JW, Despain D, Yurasov S, Litten JB, Erlander M, Raponi M, Wakelee HA. EGFR Genotyping of Matched Urine, Plasma, and Tumor Tissue in Patients With Non–Small-Cell Lung Cancer Treated With Rociletinib, an EGFR Tyrosine Kinase Inhibitor. JCO Precis Oncol 2018; 2:1-13. [DOI: 10.1200/po.17.00116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Liquid biopsies represent an attractive alternative to tissue biopsies, particularly rebiopsies, in determining patient eligibility for targeted therapies. Clinical utility of urine genotyping, however, has not been explored extensively. We evaluated epidermal growth factor receptor ( EGFR) T790M detection in matched urine, plasma, and tissue and the clinical outcomes of patients with advanced non–small-cell lung cancer treated with rociletinib. Methods Tissue (n = 540), plasma (n = 482), and urine (n = 213) were collected from evaluable patients enrolled in TIGER-X, a phase I/II study. Genotyping was performed by therascreen EGFR testing in tissue, BEAMing in plasma, and a quantitative short footprint assay (Trovera) in urine, which was used to further examine discordant samples. Results Positive percent agreement with tissue T790M results was similar for urine (82%; 142 of 173) and plasma (81%; 313 of 387) genotyping. Urine and plasma together identified more patients who were T790M positive (92%) than tissue alone (83%) among matched samples (n = 177). The ability to identify mutations in plasma was strongly associated with M stage ( P < .001); rate of T790M detection for patients with M1a/M0 disease increased from 54% for plasma alone to 85% when urine and plasma were both examined. Objective response rates of patients who were T790M positive were comparable between tumor (34%), plasma (32%), and urine (37%). Conclusion Clinical response to rociletinib was comparable irrespective of whether T790M status was identified by liquid or tissue biopsy. Combined, urine and plasma identified a higher percentage of patients who were T790M positive than tumor genotyping alone and improved detection of T790M, particularly in the absence of distant metastases. These findings support the noninvasive analysis of urine and plasma before tumor rebiopsy when assessing T790M status.
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Affiliation(s)
- Jonathan W. Goldman
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Chris Karlovich
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Lecia V. Sequist
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vlada Melnikova
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Aleksandra Franovic
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Shirish M. Gadgeel
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Karen L. Reckamp
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - D. Ross Camidge
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Maurice Pérol
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sai-Hong Ignatius Ou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Stephen V. Liu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Helena A. Yu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jean-Charles Soria
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark A. Socinski
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Tarek M. Mekhail
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Benjamin J. Solomon
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Ronald B. Natale
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Gregory A. Otterson
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vassiliki Papadimitrakopoulou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Corey J. Langer
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Joel W. Neal
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Darrin Despain
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sergey Yurasov
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jason B. Litten
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark Erlander
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mitch Raponi
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Heather A. Wakelee
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
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7
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Wu S, Zhu L, Tu L, Chen S, Huang H, Zhang J, Ma S, Zhang S. AZD9291 Increases Sensitivity to Radiation in PC-9-IR Cells by Delaying DNA Damage Repair after Irradiation and Inducing Apoptosis. Radiat Res 2018; 189:283-291. [PMID: 29332537 DOI: 10.1667/rr14682.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AZD9291 is a novel, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), which is administered orally. It has been proven effective in non-small cell lung cancer (NSCLC) patients, with both EGFR-sensitizing and EGFR T790M mutations in preclinical models. However, the potential therapeutic effects of AZD9291 combined with other modalities, including ionizing radiation, are not well understood. The presence of AZD9291 significantly increases the cell-killing effects of radiation in PC-9-IR cells with a secondary EGFR mutation (T790M), which was developed from NSCLC PC-9 cells (human lung adenocarcinoma cell with EGFR 19 exon 15 bp deletion) after chronic exposure to increasing doses of gefitinib, and in H1975 cells (human lung adenocarcinoma cell with EGFR exon 20 T790M mutation de novo), but not in PC-9 cells or in H460 cells (human lung adenocarcinoma cell with wild-type EGFR). In PC-9-IR cells, AZD9291 remarkably decreases phosphorylation levels of EGFR, extracellular regulated protein kinase (ERK), and protein kinase B (AKT). AZD9291 increases sensitivity to radiation in PC-9-IR cells by delaying deoxyribonucleic acid (DNA) damage repair after irradiation and inducing apoptosis, and enhances tumor growth inhibition when combined with radiation in PC-9-IR xenografts. Our findings suggest a potential therapeutic effect of AZD9291 as a radiation sensitizer in lung cancer cells with an acquired EGFR T790M mutation, providing a rationale for a clinical trial using the combination of AZD9291 and radiation in NSCLCs harboring acquired T790M mutation.
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Affiliation(s)
- Shenghai Wu
- a Department of Laboratory, Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lucheng Zhu
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Linglan Tu
- c Centre of Molecular Medicine, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Sumei Chen
- d Department of Oncology, Hangzhou Cancer Hospital, Hangzhou, China; and
| | - Haixiu Huang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Jingjing Zhang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Shenglin Ma
- e Department of Oncology, Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shirong Zhang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
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8
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Horn L, Gettinger S, Camidge DR, Smit EF, Janjigian YY, Miller VA, Pao W, Freiwald M, Fan J, Wang B, Chand VK, Groen HJM. Continued use of afatinib with the addition of cetuximab after progression on afatinib in patients with EGFR mutation-positive non-small-cell lung cancer and acquired resistance to gefitinib or erlotinib. Lung Cancer 2017; 113:51-58. [PMID: 29110849 DOI: 10.1016/j.lungcan.2017.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/30/2017] [Accepted: 08/15/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES In a phase Ib trial, afatinib plus cetuximab demonstrated promising clinical activity (objective response rate [ORR]: 29%; median progression-free survival [PFS]: 4.7 months) in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) with acquired resistance to erlotinib or gefitinib. Here, a separate cohort exploring afatinib plus cetuximab after progression on afatinib is reported. MATERIALS AND METHODS Patients with EGFR mutation-positive NSCLC who progressed on erlotinib or gefitinib received afatinib 40mg daily until progression, followed by afatinib daily plus cetuximab 500mg/m2 every 2 weeks until progression or intolerable adverse events (AEs). Endpoints included safety, ORR, and PFS. RESULTS Thirty-seven patients received afatinib monotherapy. Two (5%) patients responded; median PFS was 2.7 months. Thirty-six patients transitioned to afatinib plus cetuximab. Four (11%) patients responded; median PFS was 2.9 months. Median PFS with afatinib plus cetuximab for patients who received afatinib monotherapy for ≥12 versus <12 weeks was 4.9 versus 1.8 months (p=0.0354), and for patients with T790M-positive versus T790M-negative tumors was 4.8 versus 1.8 months (p=0.1306). Fifty percent of patients receiving afatinib plus cetuximab experienced drug-related grade 3/4 AEs. The most frequent drug-related AEs (any grade) were diarrhea (70%), rash (49%), and fatigue (35%) with afatinib monotherapy and rash (69%), paronychia (39%), and dry skin (36%) with afatinib plus cetuximab. CONCLUSION Sequential EGFR blockade with afatinib followed by afatinib plus cetuximab had a predictable safety profile and demonstrated modest activity in patients with EGFR mutation-positive NSCLC with resistance to erlotinib or gefitinib. CLINICALTRIALS. GOV IDENTIFIER NCT01090011.
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Affiliation(s)
- Leora Horn
- Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN, USA.
| | - Scott Gettinger
- Yale University School of Medicine and Yale Cancer Center, 333 Cedar Street, FMP 127, New Haven, CT, USA.
| | - D Ross Camidge
- University of Colorado Cancer Center, 12801 E. 17th Avenue, Aurora, CO, USA.
| | - Egbert F Smit
- Vrije Universiteit VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Yelena Y Janjigian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, 300 E66th Street, Room 1033, New York, NY, USA.
| | - Vincent A Miller
- Foundation Medicine, Inc., 150 Second Street, Cambridge, MA, USA.
| | - William Pao
- Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN, USA.
| | - Matthias Freiwald
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, Biberach, Germany.
| | - Jean Fan
- Boehringer Ingelheim Pharmaceuticals Inc., 900 Ridgebury Road, Ridgefield, CT, USA.
| | - Bushi Wang
- Boehringer Ingelheim Pharmaceuticals Inc., 900 Ridgebury Road, Ridgefield, CT, USA.
| | - Vikram K Chand
- Boehringer Ingelheim Pharmaceuticals Inc., 900 Ridgebury Road, Ridgefield, CT, USA.
| | - Harry J M Groen
- University of Groningen and University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.
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9
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Barnes TA, O'Kane GM, Vincent MD, Leighl NB. Third-Generation Tyrosine Kinase Inhibitors Targeting Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer. Front Oncol 2017; 7:113. [PMID: 28620581 PMCID: PMC5449484 DOI: 10.3389/fonc.2017.00113] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
Sensitizing mutations in the epidermal growth factor receptor (EGFR) predict response to EGFR tyrosine kinase inhibitors (TKIs) and both first- and second-generation TKIs are available as first-line treatment options in patients with advanced EGFR-mutant non-small cell lung cancer. Eventual resistance develops with multiple mechanisms identifiable both upon repeat biopsy and in plasma circulating tumor DNA. The T790M gatekeeper mutation is responsible for almost 60% of cases. A number of third-generation TKIs are in clinical development, and osimertinib has been approved by the US Food and Drug Administration for the treatment of patients with EGFR T790M mutant lung cancer after failure of initial EGFR kinase therapy. Resistance mechanisms are being identified to these novel agents, and the treatment landscape of EGFR-mutant lung cancer continues to evolve. The sequence of EGFR TKIs may change in the future and combination therapies targeting resistance appear highly promising.
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Affiliation(s)
- Tristan A Barnes
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Grainne M O'Kane
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mark David Vincent
- Department of Medical Oncology, London Regional Cancer Centre, London, ON, Canada
| | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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10
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Passaro A, Guerini-Rocco E, Pochesci A, Vacirca D, Spitaleri G, Catania CM, Rappa A, Barberis M, de Marinis F. Targeting EGFR T790M mutation in NSCLC: From biology to evaluation and treatment. Pharmacol Res 2017; 117:406-415. [DOI: 10.1016/j.phrs.2017.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 02/06/2023]
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11
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Hirsch FR, Scagliotti GV, Mulshine JL, Kwon R, Curran WJ, Wu YL, Paz-Ares L. Lung cancer: current therapies and new targeted treatments. Lancet 2017; 389:299-311. [PMID: 27574741 DOI: 10.1016/s0140-6736(16)30958-8] [Citation(s) in RCA: 2100] [Impact Index Per Article: 300.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lung cancer is the most frequent cause of cancer-related deaths worldwide. Every year, 1·8 million people are diagnosed with lung cancer, and 1·6 million people die as a result of the disease. 5-year survival rates vary from 4-17% depending on stage and regional differences. In this Seminar, we discuss existing treatment for patients with lung cancer and the promise of precision medicine, with special emphasis on new targeted therapies. Some subgroups, eg-patients with poor performance status and elderly patients-are not specifically addressed, because these groups require special treatment considerations and no frameworks have been established in terms of new targeted therapies. We discuss prevention and early detection of lung cancer with an emphasis on lung cancer screening. Although we acknowledge the importance of smoking prevention and cessation, this is a large topic beyond the scope of this Seminar.
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Affiliation(s)
- Fred R Hirsch
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Denver, CO, USA; International Association for the Study of Lung Cancer, Aurora, CO, USA.
| | - Giorgio V Scagliotti
- Division of Oncology, Department of Oncology, San Luigi Hospital-Orbassano, University of Torino, Orbassano, Italy
| | | | - Regina Kwon
- School of Medicine, University of Colorado, Denver, CO, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Luis Paz-Ares
- Medical Oncology Department, Hospital Universitario Doce de Octubre and CNIO, Madrid, Spain
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12
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Sullivan I, Planchard D. Next-Generation EGFR Tyrosine Kinase Inhibitors for Treating EGFR-Mutant Lung Cancer beyond First Line. Front Med (Lausanne) 2017; 3:76. [PMID: 28149837 PMCID: PMC5241298 DOI: 10.3389/fmed.2016.00076] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) against the human epidermal growth factor receptor (EGFR) are now standard treatment in the clinic for patients with advanced EGFR mutant non-small-cell lung cancer (NSCLC). First-generation EGFR TKIs, binding competitively and reversibly to the ATP-binding site of the EGFR tyrosine kinase domain, have resulted in a significant improvement in outcome for NSCLC patients with activating EGFR mutations (L858R and Del19). However, after a median duration of response of ~12 months, all patients develop tumor resistance, and in over half of these patients this is due to the emergence of the EGFR T790M resistance mutation. The second-generation EGFR/HER TKIs were developed to treat resistant disease, targeting not only T790M but EGFR-activating mutations and wild-type EGFR. Although they exhibited promising anti-T790M activity in the laboratory, their clinical activity among T790M+ NSCLC was poor mainly because of dose-limiting toxicity due to simultaneous inhibition of wild-type EGFR. The third-generation EGFR TKIs selectively and irreversibly target EGFR T790M and activating EGFR mutations, showing promising efficacy in NSCLC resistant to the first- and second-generation EGFR TKIs. They also appear to have lower incidences of toxicity due to the limited inhibitory effect on wild-type EGFR. Currently, the first-generation gefitinib and erlotinib and second-generation afatinib have been approved for first-line treatment of metastatic NSCLC with activating EGFR mutations. Among the third-generation EGFR TKIs, osimertinib is today the only drug approved by the Food and Drug Administration and the European Medicines Agency to treat metastatic EGFR T790M NSCLC patients who have progressed on or after EGFR TKI therapy. In this review, we summarize the available post-progression therapies including third-generation EGFR inhibitors and combination treatment strategies for treating patients with NSCLC harboring EGFR mutations and address the known mechanisms of resistance.
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Affiliation(s)
- Ivana Sullivan
- Department Medical Oncology, Gustave Roussy, Villejuif, France
| | - David Planchard
- Department Medical Oncology, Gustave Roussy, Villejuif, France
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13
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Treatment in EGFR-mutated Non-small Cell Lung Cancer: How to Block the Receptor and overcome Resistance Mechanisms. TUMORI JOURNAL 2017; 103:325-337. [DOI: 10.5301/tj.5000663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
In non-small cell lung cancer (NSCLC), the identification of epidermal growth factor receptor (EGFR) mutations and the parallel development of EGFR tyrosine kinase inhibitors (TKIs) have radically changed the therapeutic management strategies. Currently, erlotinib, gefitinib, and afatinib are all approved as standard first-line treatment in EGFR-mutated NSCLC. However, despite the proven efficacy, some EGFR-mutated NSCLCs do not respond to EGFR TKIs, while some patients, after a favorable and prolonged response to EGFR TKIs, inevitably progress within about 10-14 months. Epidermal growth factor receptor-dependent mechanisms, activation of alternative pathways, or phenotypic transformation can cause the resistance to EGFR TKIs. The exon 20 p.Thr790Met point mutation (T790M) is responsible for about 60% of cases of resistance when progression occurs. A third-generation TKI, osimertinib, improved outcome in patients harboring T790M after first- and second-generation TKI treatment. However, resistance develops even after treatment with third-generation drugs. To date, the Cys797Ser (C797S) mutation in exon 20 of EGFR is the most well-known resistance mutation after osimertinib. Fourth-generation TKIs are already under development. Nevertheless, additional information is needed to better understand and effectively overcome resistance. The aim of this review is to report recent advances and future perspectives in the treatment of EGFR-mutated NSCLC, highlighting the resistance mechanisms that underlie disease progression.
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14
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Normanno N, Maiello MR, Chicchinelli N, Iannaccone A, Esposito C, De Cecio R, D’alessio A, De Luca A. Targeting the EGFR T790M mutation in non-small-cell lung cancer. Expert Opin Ther Targets 2016; 21:159-165. [DOI: 10.1080/14728222.2017.1272582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Monica Rosaria Maiello
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Nicoletta Chicchinelli
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Alessia Iannaccone
- Laboratory of Pharmacogenomics, CROM-Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Claudia Esposito
- Laboratory of Pharmacogenomics, CROM-Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Rossella De Cecio
- Surgical Pathology Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Amelia D’alessio
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
| | - Antonella De Luca
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori ‘Fondazione G. Pascale’-IRCCS, Naples, Italy
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15
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Borsu L, Intrieri J, Thampi L, Yu H, Riely G, Nafa K, Chandramohan R, Ladanyi M, Arcila ME. Clinical Application of Picodroplet Digital PCR Technology for Rapid Detection of EGFR T790M in Next-Generation Sequencing Libraries and DNA from Limited Tumor Samples. J Mol Diagn 2016; 18:903-911. [PMID: 27631691 PMCID: PMC5807920 DOI: 10.1016/j.jmoldx.2016.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/08/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022] Open
Abstract
Although next-generation sequencing (NGS) is a robust technology for comprehensive assessment of EGFR-mutant lung adenocarcinomas with acquired resistance to tyrosine kinase inhibitors, it may not provide sufficiently rapid and sensitive detection of the EGFR T790M mutation, the most clinically relevant resistance biomarker. Here, we describe a digital PCR (dPCR) assay for rapid T790M detection on aliquots of NGS libraries prepared for comprehensive profiling, fully maximizing broad genomic analysis on limited samples. Tumor DNAs from patients with EGFR-mutant lung adenocarcinomas and acquired resistance to epidermal growth factor receptor inhibitors were prepared for Memorial Sloan-Kettering-Integrated Mutation Profiling of Actionable Cancer Targets sequencing, a hybrid capture-based assay interrogating 410 cancer-related genes. Precapture library aliquots were used for rapid EGFR T790M testing by dPCR, and results were compared with NGS and locked nucleic acid-PCR Sanger sequencing (reference high sensitivity method). Seventy resistance samples showed 99% concordance with the reference high sensitivity method in accuracy studies. Input as low as 2.5 ng provided a sensitivity of 1% and improved further with increasing DNA input. dPCR on libraries required less DNA and showed better performance than direct genomic DNA. dPCR on NGS libraries is a robust and rapid approach to EGFR T790M testing, allowing most economical utilization of limited material for comprehensive assessment. The same assay can also be performed directly on any limited DNA source and cell-free DNA.
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Affiliation(s)
- Laetitia Borsu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Julie Intrieri
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Linta Thampi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Helena Yu
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gregory Riely
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Khedoudja Nafa
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Raghu Chandramohan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; Human Oncology & Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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16
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Hirsch FR, Suda K, Wiens J, Bunn PA. New and emerging targeted treatments in advanced non-small-cell lung cancer. Lancet 2016; 388:1012-24. [PMID: 27598681 DOI: 10.1016/s0140-6736(16)31473-8] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
Targeted therapies are substantially changing the management of lung cancers. These treatments include drugs that target driver mutations, those that target presumed important molecules in cancer cell proliferation and survival, and those that inhibit immune checkpoint molecules. This area of research progresses day by day, with novel target discoveries, novel drug development, and use of novel combination treatments. Researchers and clinicians have also extensively investigated the predictive biomarkers and the molecular mechanisms underlying inherent or acquired resistance to these targeted therapies. We review recent progress in the development of targeted treatments for patients with advanced non-small-cell lung cancer, especially focusing on data from published clinical trials.
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Affiliation(s)
- Fred R Hirsch
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA; International Association for the Study of Lung Cancer, Aurora, CO, USA.
| | - Kenichi Suda
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jacinta Wiens
- International Association for the Study of Lung Cancer, Aurora, CO, USA
| | - Paul A Bunn
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA
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17
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Castellanos EH, Horn L. Generations of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors: Perils and Progress. Curr Treat Options Oncol 2016; 16:51. [PMID: 26364032 DOI: 10.1007/s11864-015-0365-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT Epidermal growth factor receptor (EGFR) mutations have been detected in approximately 10 % of North American patients diagnosed with non-small cell lung cancer (NSCLC). Approximately 90 % of these mutations are exon 19 deletions or exon 21 L858R point mutations. First- and second-generation EGFR tyrosine kinase inhibitors (TKIs) are approved as first-line therapy based on clinical trials demonstrating superior response rates, progression free survival (PFS), and overall survival (OS) compared to chemotherapy in patients with EGFR mutation-positive NSCLC treated with an EGFR TKI prior to chemotherapy. However, the majority of patients treated with an EGFR TKI develop resistance to therapy within about 12 months, approximately 50 % of patients due to a second site mutation, the T790M mutation occurring within exon 20. At the time of progression, the EGFR TKI is most commonly discontinued and a different systemic therapy is initiated. However, oncogene addiction persists and recent exciting data with third-generation EGFR TKIs suggests that acquired resistance may be surmountable. The newest EGFR TKIs have shown activity against EGFR-mutant NSCLC after progression on first-generation TKIs, including those with T90M, while sparing wild-type EGFR and hence appear to be both well tolerated and efficacious. At this time, it appears that third-generation EGFR TKIs are effective following first-generation therapy, and determining the most appropriate sequence to maximize overall survival is a matter of ongoing investigation. As the arsenal of active agents in EGFR mutant NSCLC grows, future research into potential combinations, optimal timing, and resistance mechanisms of these new treatments, as well as their possible role in the adjuvant, post-chemoradiation, and neoadjuvant settings holds great promise for this group of patients.
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Affiliation(s)
- Emily H Castellanos
- Vanderbilt Ingram Cancer Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA
| | - Leora Horn
- Vanderbilt Ingram Cancer Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA.
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19
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Bennati C, Paglialunga L, Ricciuti B, Metro G, Marcomigni L, Gili A, Crinò L. Targeting EGFR and ALK in NSCLC: current evidence and future perspective. Lung Cancer Manag 2016; 5:79-90. [PMID: 30643552 PMCID: PMC6310340 DOI: 10.2217/lmt-2016-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022] Open
Abstract
The advent of molecular therapy targeting specific driver oncogenes has dramatically changed the prognosis of a subset of NSCLC, dilating survival and improving the quality of life of patients with advanced disease. Two of the major targets for treatment with receptor TKIs are the activated mutated forms of the EGFR and the ALK gene fusions. In advanced NSCLC patients harboring EGFR mutations or ALK rearrangements, the use of TKIs in the first-line setting, have provided unexpected large progression-free survival and overall survival benefits, compared with cytotoxic chemotherapy. However, despite initial responses and durable remissions, the development of resistance inevitably leads to treatment failure. The aim of this review is to discuss the treatment strategy currently used for tumors harboring these two genetic targets and to focus on what will be available in clinical practice in the near future.
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Affiliation(s)
- Chiara Bennati
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Luca Paglialunga
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Biagio Ricciuti
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Giulio Metro
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Luca Marcomigni
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Alessio Gili
- Department of Experimental Medicine, S Maria della Misericordia Hospital, Perugia/Italy
| | - Lucio Crinò
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
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20
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Romanidou O, Landi L, Cappuzzo F, Califano R. Overcoming resistance to first/second generation epidermal growth factor receptor tyrosine kinase inhibitors and ALK inhibitors in oncogene-addicted advanced non-small cell lung cancer. Ther Adv Med Oncol 2016; 8:176-87. [PMID: 27239236 PMCID: PMC4872250 DOI: 10.1177/1758834016631531] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) activating mutations and anaplastic lymphoma kinase (ALK) gene rearrangement in advanced non-small cell lung cancer (NSCLC) represent the two oncogenic events with an impact on current clinical practice. EGFR tyrosine kinase inhibitors (TKIs) and crizotinib are the standard of care for the treatment of EGFR mutant and ALK gene rearranged advanced NSCLC patients. Unfortunately, despite initial clinical benefit, acquired resistance to EGFR-TKIs or crizotinib usually develops after an average of 10-12 months of treatment. The aim of this review is to describe the mechanisms of resistance to first/second generation EGFR-TKIs and crizotinib. In particular, we focus on strategies to overcome resistance due to secondary EGFR T790M mutation and mutations of the ALK domain.
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Affiliation(s)
- Ourania Romanidou
- Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK, and Medical Oncology Unit, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Lorenza Landi
- Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Federico Cappuzzo
- Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Raffaele Califano
- Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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21
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Califano R, Romanidou O, Mountzios G, Landi L, Cappuzzo F, Blackhall F. Management of NSCLC Disease Progression After First-Line EGFR Tyrosine Kinase Inhibitors: What Are the Issues and Potential Therapies? Drugs 2016; 76:831-40. [PMID: 27129321 DOI: 10.1007/s40265-016-0578-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent the standard of care for advanced non-small cell lung cancer (NSCLC) patients whose tumor harbors an activating EGFR mutation. The vast majority of patients will experience disease control with an EGFR-TKI but inevitably all patients will progress, often within a year of treatment. There is no current standard of care for this scenario but, in clinical practice, most of the patients will be offered platinum-based doublet chemotherapy. In some situations, continuation of the EGFR-TKI beyond radiological progression, with or without use of local treatments in case of oligo-progressive disease, represents a reasonable therapeutic option. The aim of this review is to describe the different treatment strategies that have been developed to tackle progression on EGFR-TKIs, including specific clinical scenarios and novel agents designed to tackle the common T790M resistance mutation.
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Affiliation(s)
- Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.
- Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
| | - Ourania Romanidou
- Medical Oncology Unit, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Giannis Mountzios
- Department of Medical Oncology, University of Athens School of Medicine, Athens, Greece
| | - Lorenza Landi
- Istituto Toscano Tumori, Ospedale Civile di Livorno,, Leghorn, Italy
| | - Federico Cappuzzo
- Istituto Toscano Tumori, Ospedale Civile di Livorno,, Leghorn, Italy
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- University of Manchester, Manchester, UK
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22
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Zhou C, Yao LD. Strategies to Improve Outcomes of Patients with EGFR-Mutant Non–Small Cell Lung Cancer: Review of the Literature. J Thorac Oncol 2016; 11:174-86. [DOI: 10.1016/j.jtho.2015.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/29/2023]
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Abstract
Identification of driver mutations in adenocarcinoma of the lung has revolutionized the treatment of this disease. It is now standard of care to look for activating mutations in epidermal growth factor receptor (EGFR), and translocations in anaplastic lymphoma kinase (ALK) or ROS1 in all newly diagnosed adenocarcinoma of the lung, and in many patients with squamous cell carcinoma as well. Recognition of multiple other lung cancer driver mutations has also expanded treatment options. Targeted treatments of these mutations lead to rapid and prolonged responses, but resistance inevitably develops. Until recently, traditional chemotherapy was the only alternative at that time, but better understanding of resistance mechanisms has lead to additional therapeutic options. These mechanisms of resistance and treatments are the focus of this chapter. Understanding of mechanisms of chemotherapy resistance is touched upon, along with a brief discussion of immune checkpoint inhibitors.
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Affiliation(s)
- Gabriel Rivera
- Stanford University, Kaiser Permanente Fresno, Stanford, USA
| | - Heather A Wakelee
- Stanford University, Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305-5826, USA.
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Piotrowska Z, Sequist LV. Continued EGFR Inhibition With Postprogression Chemotherapy: Where Do We Stand? Oncologist 2015; 20:1230-2. [PMID: 26500230 DOI: 10.1634/theoncologist.2015-0370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/07/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Zofia Piotrowska
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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