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Enrico D, Tsou F, Catani G, Pupareli C, Girotti MR, Ulloa Alvarez DE, Waisberg F, Rodríguez A, Reyes R, Chacón M, Reguart N, Martín C. Overcoming Resistance to Osimertinib by T790M Loss and C797S Acquisition Using Gefitinib in a Patient With EGFR-Mutant NSCLC: A Case Report. JTO Clin Res Rep 2022; 4:100456. [PMID: 36798785 PMCID: PMC9926104 DOI: 10.1016/j.jtocrr.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Limited strategies are available at disease progression on osimertinib for patients with EGFR-mutant NSCLC. The emergence of the on-target EGFR C797S mutation has been described as one of the most common mechanisms of resistance. In addition, loss of the EGFR T790M mutation has been mainly investigated as a resistance phenomenon to second-line osimertinib exposure. Remarkably, by studying the molecular profile at progression, it has been reported that the presence of the EGFR-sensitizing mutation, concurrently with the T790M, and C797S resulted in resistance to the current available EGFR tyrosine kinase inhibitors. Here, we report the first clinical evidence of gefitinib efficacy at EGFR exon 19 deletion/C797S mutation/T790M loss-mediated resistance to first-line osimertinib. Our findings highlight that dynamic genetic monitoring is a crucial approach in the evolution of EGFR-mutant NSCLC to understand the acquired molecular mechanisms for driving the best treatment strategy.
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Affiliation(s)
- Diego Enrico
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Corresponding author. Address for correspondence: Diego Enrico, MD, Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, 1180 Crámer, Buenos Aires (1426), Argentina.
| | - Florencia Tsou
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Greta Catani
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Carmen Pupareli
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
| | | | | | - Federico Waisberg
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Andrés Rodríguez
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Roxana Reyes
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Matías Chacón
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Noemí Reguart
- Thoracic Oncology Unit, Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Claudio Martín
- Thoracic Oncology Unit, Department of Medical Oncology, Alexander Fleming Cancer institute, Buenos Aires, Argentina
- Clinical Research Unit, Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
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