Research Papers:

Targeted sequencing identifies genetic alterations that confer primary resistance to EGFR tyrosine kinase inhibitor (Korean Lung Cancer Consortium)

Sun Min Lim _, Hye Ryun Kim, Eun Kyung Cho, Young Joo Min, Jin Seok Ahn, Myung-Ju Ahn, Keunchil Park, Byoung Chul Cho, Ji-Hyun Lee, Hye Cheol Jeong, Eun Kyung Kim and Joo-Hang Kim

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Oncotarget. 2016; 7:36311-36320. https://doi.org/10.18632/oncotarget.8904

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Sun Min Lim1,2*, Hye Ryun Kim1*, Eun Kyung Cho3, Young Joo Min4, Jin Seok Ahn5, Myung-Ju Ahn5, Keunchil Park5, Byoung Chul Cho1, Ji-Hyun Lee6, Hye Cheol Jeong6, Eun Kyung Kim6, Joo-Hang Kim2

1Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea

2Department of Internal Medicine, Division of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

3Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

4Department of Oncology, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Korea

5Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

6Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea

*These authors have contributed equally to this work

Correspondence to:

Joo-Hang Kim, email: [email protected]

Keywords: primary resistance, epidermal growth factor, next-generation sequencing, tyrosine kinase inhibitor

Received: March 01, 2016    Accepted: April 05, 2016    Published: April 21, 2016


Background: Non-small-cell lung cancer (NSCLC) patients with activating epidermal growth factor receptor (EGFR) mutations may exhibit primary resistance to EGFR tyrosine kinase inhibitor (TKI). We aimed to examine genomic alterations associated with de novo resistance to gefitinib in a prospective study of NSCLC patients.

Methods: One-hundred and fifty two patients with activating EGFR mutations were included in this study and 136 patients’ tumor sample were available for targeted sequencing of genomic alterations in 22 genes using the Colon and Lung Cancer panel (Ampliseq, Life Technologies).

Results: All 132 patients with EGFR mutation were treated with gefitinib for their treatment of advanced NSCLC. Twenty patients showed primary resistance to EGFR TKI, and were classified as non-responders. A total of 543 somatic single-nucleotide variants (498 missense, 13 nonsense) and 32 frameshift insertions/deletions, with a median of 3 mutations per sample. TP53 was most commonly mutated (47%) and mutations in SMAD4 was also common (19%), as well as DDR2 (16%), PIK3CA (15%), STK11 (14%), and BRAF (7%). Genomic mutations in the PI3K/Akt/mTOR pathway were commonly found in non-responders (45%) compared to responders (27%), and they had significantly shorter progression-free survival and overall survival compared to patients without mutations (2.1 vs. 12.8 months, P=0.04, 15.7 vs. not reached, P<0.001). FGFR 1-3 alterations, KRAS mutations and TP53 mutations were more commonly detected in non-responders compared to responders.

Conclusion: Genomic mutations in the PI3K/Akt/mTOR pathway were commonly identified in non-responders and may confer resistance to EGFR TKI. Screening lung adenocarcinoma patients with clinical cancer gene test may aid in selecting out those who show primary resistance to EGFR TKI (NCT01697163).

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