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Joshi A, Butle A, Hait S, Mishra R, Trivedi V, Thorat R, Choughule A, Noronha V, Prabhash K, Dutt A. Osimertinib for lung cancer cells harboring low-frequency EGFR T790M mutation. Transl Oncol 2022; 22:101461. [PMID: 35653897 PMCID: PMC9156817 DOI: 10.1016/j.tranon.2022.101461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/11/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/25/2022] Open
Abstract
Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, shows significant benefit among patients with EGFR T790M mutation at disease progression. We analyzed the whole exome sequence of 48 samples obtained from 16 lung cancer patients with a longitudinal follow-up: treatment-naïve-baseline primary tumors positive for EGFR activating-mutations, paired re-biopsies upon disease progression but negative for EGFR T790M mutation based on qPCR, and their matched normal blood samples. Our Next generation sequencing (NGS) analysis identified an additional set of 25% re-biopsy samples to harbor EGFR T790M mutation occurring at a low-allele frequency of 5% or less, undetectable by conventional qPCR-based assays. Notably, the clinical utility of osimertinib among patients harboring low-allele frequency of EGFR T790M in tissue biopsy upon disease progression remains less explored. We established erlotinib-resistant PC-9R cells and twenty single-cell sub-clones from erlotinib-sensitive lung cancer PC-9 cells using in vitro drug-escalation protocol. NGS and allele-specific PCR confirmed the low-allele frequency of EGFR T790M present at 5% with a 100-fold higher resistance to erlotinib in the PC-9R cells and its sub-clones. Additionally, luciferase tagged PC-9, and PC-9R cells were orthotopically injected through the intercostal muscle into NOD-SCID mice. The orthotopic lung tumors formed were observed by non-invasive bioluminescence imaging. Consistent with in vitro data, osimertinib, but not erlotinib, caused tumor regression in mice injected with PC-9R cells, while both osimertinib and erlotinib inhibited tumors in mice injected with PC-9 cells. Taken together, our findings could extend the benefit of osimertinib treatment to patients with low EGFR T790M mutation allele frequency on disease progression.
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Affiliation(s)
- Asim Joshi
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India 410210; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Ashwin Butle
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India 410210
| | - Supriya Hait
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India 410210; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Rohit Mishra
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India 410210
| | - Vaishakhi Trivedi
- Department of Medical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, India 400012; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Rahul Thorat
- Laboratory Animal Facility, Advanced Centre for Treatment Research and Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, 410210
| | - Anuradha Choughule
- Department of Medical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, India 400012; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, India 400012; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, India 400012; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094
| | - Amit Dutt
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education In Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India 410210; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India 400094.
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