title: Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib.
abstract: BACKGROUND
  Most patients with non-small-cell lung cancer have no response to the tyrosine kinase inhibitor gefitinib, which targets the epidermal growth factor receptor (EGFR). However, about 10 percent of patients have a rapid and often dramatic clinical response. The molecular mechanisms underlying sensitivity to gefitinib are unknown.
  
  
  METHODS
  We searched for mutations in the EGFR gene in primary tumors from patients with non-small-cell lung cancer who had a response to gefitinib, those who did not have a response, and those who had not been exposed to gefitinib. The functional consequences of identified mutations were evaluated after the mutant proteins were expressed in cultured cells.
  
  
  RESULTS
  Somatic mutations were identified in the tyrosine kinase domain of the EGFR gene in eight of nine patients with gefitinib-responsive lung cancer, as compared with none of the seven patients with no response (P<0.001). Mutations were either small, in-frame deletions or amino acid substitutions clustered around the ATP-binding pocket of the tyrosine kinase domain. Similar mutations were detected in tumors from 2 of 25 patients with primary non-small-cell lung cancer who had not been exposed to gefitinib (8 percent). All mutations were heterozygous, and identical mutations were observed in multiple patients, suggesting an additive specific gain of function. In vitro, EGFR mutants demonstrated enhanced tyrosine kinase activity in response to epidermal growth factor and increased sensitivity to inhibition by gefitinib.
  
  
  CONCLUSIONS
  A subgroup of patients with non-small-cell lung cancer have specific mutations in the EGFR gene, which correlate with clinical responsiveness to the tyrosine kinase inhibitor gefitinib. These mutations lead to increased growth factor signaling and confer susceptibility to the inhibitor. Screening for such mutations in lung cancers may identify patients who will have a response to gefitinib.
authors.affiliation: Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston 02129, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lynch
authors.forename: Daphne W
authors.initials: DW
authors.lastname: Bell
authors.forename: Raffaella
authors.initials: R
authors.lastname: Sordella
authors.forename: Sarada
authors.initials: S
authors.lastname: Gurubhagavatula
authors.forename: Ross A
authors.initials: RA
authors.lastname: Okimoto
authors.forename: Brian W
authors.initials: BW
authors.lastname: Brannigan
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Harris
authors.forename: Sara M
authors.initials: SM
authors.lastname: Haserlat
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Supko
authors.forename: Frank G
authors.initials: FG
authors.lastname: Haluska
authors.forename: David N
authors.initials: DN
authors.lastname: Louis
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.forename: Jeff
authors.initials: J
authors.lastname: Settleman
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Haber
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001483:Base Sequence; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000235:genetics*; D004252:DNA Mutational Analysis; D019008:Drug Resistance, Neoplasm / Q000235:genetics; D004815:Epidermal Growth Factor / Q000378:metabolism; D066246:ErbB Receptors / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism; D005260:Female; D000077156:Gefitinib; D018773:Genes, erbB-1; D006579:Heterozygote; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D011799:Quinazolines / Q000627:therapeutic use*; D017384:Sequence Deletion
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D004815:Epidermal Growth Factor; D066246:ErbB Receptors; D011505:Protein-Tyrosine Kinases; D000077156:Gefitinib