title: Epidermal growth factor receptor kinase domain mutations in esophageal and pancreatic adenocarcinomas.
abstract: OBJECTIVE
  Specific activating mutations within the epidermal growth factor receptor (EGFR) identify a subset of non-small cell lung cancers with dramatic sensitivity to the specific tyrosine kinase inhibitors (TKI), gefitinib and erlotinib. Despite the abundant expression of EGFR protein in a broad range of epithelial cancers, EGFR mutations have not been reported in a substantial fraction of other cancers. Given recent reports of TKI-responsive cases of esophageal and pancreatic cancer, this study was designed to determine the prevalence of EGFR mutations in these gastrointestinal cancers.
  
  
  METHODS
  We sequenced exons 18 to 21 of EGFR from 21 cases of Barrett's esophagus, 5 cases of high-grade esophageal dysplasia, 17 cases of esophageal adenocarcinoma, and 55 cases of pancreatic adenocarcinoma. Subsets of esophageal (n = 7) and pancreatic cancer cases (n = 5) were obtained from patients who were subsequently treated with gefitinib or erlotinib-capecitabine, respectively.
  
  
  RESULTS
  Mutations of EGFR were identified in two esophageal cancers (11.7%), three cases of Barrett's esophagus (14.2%), and two pancreatic cancers (3.6%). The mutations consisted of the recurrent missense L858R and in-frame deletion delE746-A750, previously characterized as activating EGFR mutations in non-small cell lung cancer. We also identified the TKI drug resistance-associated EGFR T790M mutation in an untreated case of Barrett's esophagus and the corresponding adenocarcinoma.
  
  
  CONCLUSIONS
  The presence of activating mutations within EGFR in both esophageal and pancreatic adenocarcinomas defines a previously unrecognized subset of gastrointestinal tumors in which EGFR signaling may play an important biological role. EGFR mutations in premalignant lesions of Barrett's esophagus also point to these as an early event in transformation of the esophageal epithelium. The role of genotype-directed TKI therapy should be tested in prospective clinical trials.
authors.affiliation: Massachusetts General Hospital Cancer Center and Harvard Medical School, Charlestown, Massachusetts 02129, USA.
authors.forename: Eunice L
authors.initials: EL
authors.lastname: Kwak
authors.forename: Janusz
authors.initials: J
authors.lastname: Jankowski
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Brian W
authors.initials: BW
authors.lastname: Brannigan
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Harris
authors.forename: Ross A
authors.initials: RA
authors.lastname: Okimoto
authors.forename: Sara M
authors.initials: SM
authors.lastname: Haserlat
authors.forename: David R
authors.initials: DR
authors.lastname: Driscoll
authors.forename: David
authors.initials: D
authors.lastname: Ferry
authors.forename: Beth
authors.initials: B
authors.lastname: Muir
authors.forename: Jeff
authors.initials: J
authors.lastname: Settleman
authors.forename: Charles S
authors.initials: CS
authors.lastname: Fuchs
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Jeff W
authors.initials: JW
authors.lastname: Clark
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Sgroi
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Haber
authors.forename: Daphne W
authors.initials: DW
authors.lastname: Bell
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics* / Q000378:metabolism; D000970:Antineoplastic Agents / Q000494:pharmacology; D002471:Cell Transformation, Neoplastic; D004252:DNA Mutational Analysis; D066246:ErbB Receptors / Q000737:chemistry* / Q000235:genetics*; D004938:Esophageal Neoplasms / Q000235:genetics*; D005091:Exons; D005838:Genotype; D006801:Humans; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000235:genetics*; D017434:Protein Structure, Tertiary
chemical_list: D000970:Antineoplastic Agents; D066246:ErbB Receptors