Mechanisms of acquired resistance to EGFR-tyrosine kinase inhibitor in Korean patients with lung cancer

BMC Cancer

Wonjun Ji³  Chang-Min Choi¹  Jin Kyung Rho³  Se Jin Jang²  Young Soo Park²  Sung-Min Chun²  Woo Sung Kim³  Jung-Shin Lee¹  Sang-We Kim¹  Dae Ho Lee¹  Jae Cheol Lee¹ 

[1] Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea

[2] Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

[3] Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

关键词: Mass spectrometric genotyping;    Resistant mechanism;    Acquired resistance;    EGFR tyrosine kinase inhibitor;    Epidermal growth factor receptor mutation;    Non-small cell lung carcinoma;   

Others  :  859186
DOI  :  10.1186/1471-2407-13-606

 received in 2013-07-26, accepted in 2013-12-19,  发布年份 2013

【 摘 要 】

Background

Despite an initial good response to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), resistance to treatment eventually develops. Although several resistance mechanisms have been discovered, little data exist regarding Asian patient populations.

Methods

Among patients at a tertiary referral hospital in Korea who initially responded well to gefitinib and later acquired resistance to treatment, we selected those with enough tissues obtained before EGFR-TKI treatment and after the onset of resistance to examine mutations by mass spectrometric genotyping technology (Asan-Panel), MET amplification by fluorescence in situ hybridization (FISH), and analysis of AXL status, epithelial-to-mesenchymal transition (EMT) and neuroendocrine markers by immunohistochemistry.

Results

Twenty-six patients were enrolled, all of whom were diagnosed with adenocarcinoma with EGFR mutations (19del: 16, L858R: 10) except one (squamous cell carcinoma with 19del). Secondary T790M mutation was detected in 11 subjects (42.3%) and four of these patients had other co-existing resistance mechanisms; increased AXL expression was observed in 5/26 patients (19.2%), MET gene amplification was noted in 3/26 (11.5%), and one patient acquired a mutation in the phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha isoform (PIK3CA) gene. None of the patients exhibited EMT; however, increased CD56 expression suggesting neuroendocrine differentiation was observed in two patients. Interestingly, conversion from L858R-mutant to wild-type EGFR occurred in one patient. Seven patients (26.9%) did not exhibit any known resistance mechanisms. Patients with a T790M mutation showed a more favorable prognosis.

Conclusion

The mechanisms and frequency of acquired EGFR-TKI resistance in Koreans are comparable to those observed in Western populations; however, more data regarding the mechanisms that drive EGFR-TKI resistance are necessary.

【 授权许可】

   
2013 Ji et al.; licensee BioMed Central Ltd.

【 图 表 】

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