title: Amplification of EGFR T790M causes resistance to an irreversible EGFR inhibitor.
abstract: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, gefitinib and erlotinib are effective therapies against mutant non-small cell lung cancers (NSCLCs). Treatment is limited by the development of resistance in part explained by the gain of a secondary EGFR mutation, T790M, at the gatekeeper residue. Irreversible EGFR inhibitors, including PF00299804, are effective in vitro and in vivo against EGFR mutant tumors that contain EGFR T790M and are currently under clinical development. In this study, we generate models of resistance to PF00299804, using cell lines with EGFR T790M and show that the PF00299804-resistant models develop focal amplification of EGFR that preferentially involves the T790M-containing allele. These PF00299804-resistant cell lines remain dependent on EGFR for growth as downregulation of EGFR by shRNA compromises their viability. We show that resistance to PF00299804 arises, at least in part, through selection of a pre-existing EGFR T790M-amplified clone both in vitro and using a xenograft model in vivo. Our findings show that EGFR T790M is a common resistance mechanism to both reversible, and when amplified, the irreversible EGFR kinase inhibitors further emphasizing the need to develop more potent therapies against EGFR T790M. These findings can be used to guide studies of patient tumor specimens from ongoing clinical trials of irreversible EGFR kinase inhibitors.
authors.affiliation: Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
authors.forename: D
authors.initials: D
authors.lastname: Ercan
authors.forename: K
authors.initials: K
authors.lastname: Zejnullahu
authors.forename: K
authors.initials: K
authors.lastname: Yonesaka
authors.forename: Y
authors.initials: Y
authors.lastname: Xiao
authors.forename: M
authors.initials: M
authors.lastname: Capelletti
authors.forename: A
authors.initials: A
authors.lastname: Rogers
authors.forename: E
authors.initials: E
authors.lastname: Lifshits
authors.forename: A
authors.initials: A
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: J G
authors.initials: JG
authors.lastname: Christensen
authors.forename: D J
authors.initials: DJ
authors.lastname: Kwiatkowski
authors.forename: J A
authors.initials: JA
authors.lastname: Engelman
authors.forename: P A
authors.initials: PA
authors.lastname: Jänne
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D045744:Cell Line, Tumor; D019008:Drug Resistance, Neoplasm; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics* / Q000378:metabolism; D000077156:Gefitinib; D005784:Gene Amplification; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D010766:Phosphorylation; D047428:Protein Kinase Inhibitors / Q000494:pharmacology*; D011799:Quinazolines / Q000494:pharmacology; D052999:Quinazolinones / Q000494:pharmacology
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D052999:Quinazolinones; C525726:dacomitinib; D066246:ErbB Receptors; D000077156:Gefitinib