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Grant MJ, Aredo JV, Starrett JH, Stockhammer P, van Alderwerelt van Rosenburgh IK, Wurtz A, Piper-Valillo AJ, Piotrowska Z, Falcon C, Yu HA, Aggarwal C, Scholes D, Patil T, Nguyen C, Phadke M, Li FY, Neal J, Lemmon MA, Walther Z, Politi K, Goldberg SB. Efficacy of Osimertinib in Patients with Lung Cancer Positive for Uncommon EGFR Exon 19 Deletion Mutations. Clin Cancer Res 2023; 29:2123-2130. [PMID: 36913537 PMCID: PMC10493186 DOI: 10.1158/1078-0432.ccr-22-3497] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The uncommon EGFR exon 19 deletion (ex19del), L747_A750>P, demonstrates reduced sensitivity to osimertinib compared with the common ex19del, E746_A750del in preclinical models. The clinical efficacy of osimertinib in patients with non-small cell lung cancer harboring L747_A750>P and other uncommon ex19dels is not known. EXPERIMENTAL DESIGN The AACR GENIE database was interrogated to characterize the frequency of individual ex19dels relative to other variants, and a multicenter retrospective cohort was used to compare clinical outcomes for patients with tumors harboring E746_A750del, L747_A750>P, and other uncommon ex19dels who received osimertinib in the first line (1L) or in second or later lines of therapy and were T790M+ (≥2L). RESULTS ex19dels comprised 45% of EGFR mutations, with 72 distinct variants ranging in frequency from 28.1% (E746_A750del) to 0.03%, with L747_A750>P representing 1.8% of the EGFR mutant cohort. In our multi-institutional cohort (N = 200), E746_A750del was associated with significantly prolonged progression-free survival (PFS) with 1L osimertinib versus L747_A750>P [median 21.3 months (95% confidence interval, 17.0-31.7) vs. 11.7 months (10.8-29.4); adjusted HR 0.52 (0.28-0.98); P = 0.043]. Osimertinib efficacy in patients with other uncommon ex19dels varied on the basis of the specific mutation present. CONCLUSIONS The ex19del L747_A750>P is associated with inferior PFS compared with the common E746_A750del mutation in patients treated with 1L osimertinib. Understanding differences in osimertinib efficacy among EGFR ex19del subtypes could alter management of these patients in the future.
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Affiliation(s)
- Michael J Grant
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline V Aredo
- Department of Medicine (Oncology), Stanford University, Stanford, California
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Paul Stockhammer
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Iris K van Alderwerelt van Rosenburgh
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Biology Institute, West Haven, Connecticut
| | - Anna Wurtz
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J Piper-Valillo
- Department of Medicine (Hematology/Oncology), Massachusetts General Hospital, Boston, Massachusetts
| | - Zofia Piotrowska
- Department of Medicine (Hematology/Oncology), Massachusetts General Hospital, Boston, Massachusetts
| | - Christina Falcon
- Department of Medicine (Thoracic Oncology), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena A Yu
- Department of Medicine (Thoracic Oncology), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charu Aggarwal
- Department of Medicine (Division of Hematology/Oncology), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Dylan Scholes
- Department of Medicine (Division of Hematology/Oncology), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Tejas Patil
- Department of Medicine (Division of Medical Oncology), University of Colorado School of Medicine, Aurora, Colorado
| | - Christina Nguyen
- Department of Medicine (Division of Medical Oncology), University of Colorado School of Medicine, Aurora, Colorado
| | - Manali Phadke
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Fang-Yong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Joel Neal
- Department of Medicine (Oncology), Stanford University, Stanford, California
| | - Mark A Lemmon
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Biology Institute, West Haven, Connecticut
| | - Zenta Walther
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Katerina Politi
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Sarah B Goldberg
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
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Kiyatkin A, van Alderwerelt van Rosenburgh IK, Klein DE, Lemmon MA. Kinetics of receptor tyrosine kinase activation define ERK signaling dynamics. Sci Signal 2020; 13:13/645/eaaz5267. [PMID: 32817373 DOI: 10.1126/scisignal.aaz5267] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In responses to activation of receptor tyrosine kinases (RTKs), crucial cell fate decisions depend on the duration and dynamics of ERK signaling. In PC12 cells, epidermal growth factor (EGF) induces transient ERK activation that leads to cell proliferation, whereas nerve growth factor (NGF) promotes sustained ERK activation and cell differentiation. These differences have typically been assumed to reflect distinct feedback mechanisms in the Raf-MEK-ERK signaling network, with the receptors themselves acting as simple upstream inputs. We failed to confirm the expected differences in feedback type when investigating transient versus sustained signaling downstream of the EGF receptor (EGFR) and NGF receptor (TrkA). Instead, we found that ERK signaling faithfully followed RTK dynamics when receptor signaling was modulated in different ways. EGFR activation kinetics, and consequently ERK signaling dynamics, were switched from transient to sustained when receptor internalization was inhibited with drugs or mutations, or when cells expressed a chimeric receptor likely to have impaired dimerization. In addition, EGFR and ERK signaling both became more sustained when substoichiometric levels of erlotinib were added to reduce duration of EGFR kinase activation. Our results argue that RTK activation kinetics play a crucial role in determining MAP kinase cascade signaling dynamics and cell fate decisions, and that signaling outcome can be modified by activating a given RTK in different ways.
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Affiliation(s)
- Anatoly Kiyatkin
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA.,Cancer Biology Institute, Yale University, West Haven, CT 06516, USA
| | - Iris K van Alderwerelt van Rosenburgh
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA.,Cancer Biology Institute, Yale University, West Haven, CT 06516, USA
| | - Daryl E Klein
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA.,Cancer Biology Institute, Yale University, West Haven, CT 06516, USA
| | - Mark A Lemmon
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA. .,Cancer Biology Institute, Yale University, West Haven, CT 06516, USA
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Starrett JH, Guernet A, Cuomo ME, Poels K, van Alderwerelt van Rosenburgh IK, Nagelberg A, Farnsworth D, Price K, Khan H, Ashtekar KD, Gaefele M, Ayeni D, Stewart TF, Kuhlmann A, Kaech SM, Unni AM, Homer R, Lockwood WW, Michor F, Goldberg SB, Lemmon MA, Smith P, Cross D, Politi K. Drug Sensitivity and Allele‐specificity of First‐line Osimertinib Resistance
EGFR
Mutations. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.00612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Starrett JH, Guernet AA, Cuomo ME, Poels KE, van Alderwerelt van Rosenburgh IK, Nagelberg A, Farnsworth D, Price KS, Khan H, Ashtekar KD, Gaefele M, Ayeni D, Stewart TF, Kuhlmann A, Kaech SM, Unni AM, Homer R, Lockwood WW, Michor F, Goldberg SB, Lemmon MA, Smith PD, Cross DAE, Politi K. Drug Sensitivity and Allele Specificity of First-Line Osimertinib Resistance EGFR Mutations. Cancer Res 2020; 80:2017-2030. [PMID: 32193290 DOI: 10.1158/0008-5472.can-19-3819] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/06/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Abstract
Osimertinib, a mutant-specific third-generation EGFR tyrosine kinase inhibitor, is emerging as the preferred first-line therapy for EGFR-mutant lung cancer, yet resistance inevitably develops in patients. We modeled acquired resistance to osimertinib in transgenic mouse models of EGFRL858R -induced lung adenocarcinoma and found that it is mediated largely through secondary mutations in EGFR-either C797S or L718V/Q. Analysis of circulating free DNA data from patients revealed that L718Q/V mutations almost always occur in the context of an L858R driver mutation. Therapeutic testing in mice revealed that both erlotinib and afatinib caused regression of osimertinib-resistant C797S-containing tumors, whereas only afatinib was effective on L718Q mutant tumors. Combination first-line osimertinib plus erlotinib treatment prevented the emergence of secondary mutations in EGFR. These findings highlight how knowledge of the specific characteristics of resistance mutations is important for determining potential subsequent treatment approaches and suggest strategies to overcome or prevent osimertinib resistance in vivo. SIGNIFICANCE: This study provides insight into the biological and molecular properties of osimertinib resistance EGFR mutations and evaluates therapeutic strategies to overcome resistance. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/10/2017/F1.large.jpg.
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Affiliation(s)
| | - Alexis A Guernet
- Discovery Biology, Discovery Sciences, R&D Biopharmaceuticals, AstraZeneca, Cambridge, United Kingdom
| | - Maria Emanuela Cuomo
- Discovery Biology, Discovery Sciences, R&D Biopharmaceuticals, AstraZeneca, Cambridge, United Kingdom
| | - Kamrine E Poels
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Iris K van Alderwerelt van Rosenburgh
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
| | - Amy Nagelberg
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dylan Farnsworth
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hina Khan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island; and Lifespan Cancer Institute, Providence, Rhode Island
| | - Kumar Dilip Ashtekar
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
| | | | - Deborah Ayeni
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Tyler F Stewart
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Alexandra Kuhlmann
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, The Salk Institute, La Jolla, California
| | - Arun M Unni
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Robert Homer
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Pathology and Laboratory Medicine Service, VA CT HealthCare System, West Haven, Connecticut
| | - William W Lockwood
- Department of Integrative Oncology, British Columbia Cancer and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franziska Michor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts; Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, Massachusetts; The Broad Institute of Harvard and MIT, Cambridge, Massachusetts; and The Ludwig Center at Harvard, Boston, Massachusetts
| | - Sarah B Goldberg
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Mark A Lemmon
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut
- Cancer Biology Institute, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Paul D Smith
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | - Katerina Politi
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut.
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, Connecticut
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