Acquired Concurrent EGFR T790M and Driver Gene Resistance From EGFR-TKIs Hampered Osimertinib Efficacy in Advanced Lung Adenocarcinoma: Case Reports

Frontiers in Pharmacology

Yue Zeng¹  Xiaohan Liu¹  Yue Pan¹  Xianling Liu¹  Guihua Fu²  Yuanqing Feng²  Chunhong Hu³  Fang Wu⁴  Junlan Jiang⁶ 

[1] Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China;Department of Oncology, Xiangtan Central Hospital, Xiangtan, China;Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China;Hunan Key Laboratory of Early Diagnosis and Precision Therapy in Lung Cancer, The Second Xiangya Hospital, Central South University, Changsha, China;Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China;Jiangnan Hospital, Xiangtan, China;

关键词: non-small-cell lung cancer;    EGFR-TKI acquired resistance;    T790M;    diver gene resistance;    ALK fusion;    MET amplification;   

DOI  :  10.3389/fphar.2022.838247

来源: DOAJ

【 摘 要 】

The acquired resistance of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is inevitable and heterogeneous. The strategies to overcome acquired resistance are significant. For patients with secondary T790M-positive after early generation EGFR-TKIs, osimertinib is the standard second-line therapy. In patients resistant to prior early generation EGFR-TKIs, the acquired T790M mutation overlaps with other driver gene resistance, such as HER2-and MET amplification, accounting for 4–8%. The efficacy of osimertinib is unclear in patients with concurrent multiple driver gene resistance. We here report a patient who acquired EGFR T790M, STRN-ALK fusion, and EGFR amplification after gefitinib progression and subsequent MET amplification acquired from osimertinib. The other patient acquired EGFR T790M and MET amplification post-dacomitinib and acquired CCDC6-RET fusion after osimertinib treatment. Besides, subsequent new bypass activations were the possible resistance mechanisms to second-line osimertinib. Both patients had progression-free survival (PFS) less than 4 months and limited benefits from osimertinib second-line therapy. The T790M accompanying driver gene resistance will be a new subtype after EGFR-TKIs progression, needing effective treatment options.

【 授权许可】

Unknown