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Wang L, Quan F, Guo Z, Lu Z, Yang D, Shi M. Co-Occurring EGFR S645C and EGFR L858R in a Patient with Lung Adenocarcinoma Induced Primary Resistance to Osimertinib. LUNG CANCER (AUCKLAND, N.Z.) 2023; 14:79-84. [PMID: 37842288 PMCID: PMC10576154 DOI: 10.2147/lctt.s431252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
Approximately 10-20% of patients demonstrate primary resistance to EGFR-TKIs, and different EGFR mutations vary in sensitivity to EGFR-TKIs. We report a case of a 78-year-old male with lung adenocarcinoma that EGFR L858R (AF = 1.32%) coexisting with EGFR S645C (AF = 7.13%) in his diagnosed tissues analyzed by NGS. The patient was primarily resistant to first-line osimertinib and rapidly progressed after pembrolizumab in combination with pemetrexed and bevacizumab, as demonstrated by persistently elevated CEA levels during treatment. ctDNA-based NGS analysis revealed loss of EGFR L858R while persistence of highly abundant EGFR S645C in the pleural fluid and plasma after treatment, suggesting that EGFR L858R may be a subclone. We provide the first clinical evidence of the primary resistance of EGFR S645C to osimertinib and emphasize the importance of identifying clones and subclones. Our patient did not respond to immunotherapy either, and preclinical studies have shown that EGFR S645C activates the MEK signaling pathway, the combination of EGFR-TKIs and MEK inhibitors may be effective.
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Affiliation(s)
- Li Wang
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Fei Quan
- The Medical Department, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, People’s Republic of China
| | - Zhen Guo
- Radiology Department, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhongyu Lu
- The Medical Department, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, People’s Republic of China
| | - Duoxia Yang
- The Medical Department, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, People’s Republic of China
| | - Meiqi Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Morikawa K, Kida H, Handa H, Inoue T, Saji H, Koike J, Nakamura S, Sato Y, Ueda Y, Suzuki F, Matoba R, Mineshita M. A Prospective Validation Study of Lung Cancer Gene Panel Testing Using Cytological Specimens. Cancers (Basel) 2022; 14:cancers14153784. [PMID: 35954448 PMCID: PMC9367394 DOI: 10.3390/cancers14153784] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The gold standard for genetic panel test samples is considered to be tissue specimens. However, in clinical practice, tissue specimens are often unavailable. Therefore, using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we enrolled patients who underwent diagnostic procedures to evaluate analysis accuracy, nucleic acid yield, and quality using cytological specimens. Cytological specimens were suitable for both nucleic acid yield and specimen quality due to the ease of collection and processing. Cytological sample analysis detected gene mutations in 68.7% of lung adenocarcinomas, and these samples were consistent with companion diagnostic tests 99.5% of the time. Moreover, the allele frequency of gene mutations in cytological specimens showed a high correlation with tissue specimens. This is the first study to prospectively evaluate the feasibility of a lung cancer gene panel test using cytological specimens. Abstract Background: Genetic panel tests require sufficient tissue samples, and therefore, cannot always be performed. Although collecting cytological specimens is easier than tissue collection, there are no validation studies on the diagnostic accuracy of lung cancer gene panel tests using cytology samples. Methods: Using an amplicon-based high-sensitivity next-generation sequencing panel test capable of measuring eight druggable genes, we prospectively enrolled consecutive patients who underwent diagnostic procedures. We evaluated the analysis accuracy rate, nucleic acid yield, and the quality of cytological specimens under brushing, needle aspiration, and pleural effusion. We then compared these specimens with collected tissue samples. Results: In 163 prospectively enrolled cases, nucleic acid extraction and analysis accuracy was 100% in cases diagnosed with adenocarcinoma. Gene mutations were found in 68.7% of cases with 99.5% (95% CI: 98.2–99.9) concordance to companion diagnostics. The median DNA/RNA yield and DNA/RNA integrity number were 475/321 ng and 7.9/5.7, respectively. The correlation coefficient of the gene allele ratio in 64 cases compared with tissue samples was 0.711. Conclusion: The success of gene analysis using cytological specimens was high, and the yield and quality of the extracted nucleic acid were sufficient for panel analysis. Moreover, the allele frequency of gene mutations in cytological specimens showed high correlations with tissue specimens.
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Affiliation(s)
- Kei Morikawa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
- Correspondence: ; Tel.: +81-44-977-8111; Fax: +81-44-976-5792
| | - Hirotaka Kida
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Hiroshi Handa
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Takeo Inoue
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan;
| | - Junki Koike
- Department of Pathological Diagnosis, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan;
| | - Seiji Nakamura
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Yoshiharu Sato
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Yumi Ueda
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Fumihiko Suzuki
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Ryo Matoba
- DNA Chip Research Inc., Tokyo 105-0022, Japan; (S.N.); (Y.S.); (Y.U.); (F.S.); (R.M.)
| | - Masamichi Mineshita
- Division of Respiratory Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8513, Japan; (H.K.); (H.H.); (T.I.); (M.M.)
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