title: EGFR exon 19 insertions: a new family of sensitizing EGFR mutations in lung adenocarcinoma.
abstract: OBJECTIVE
  Epidermal growth factor receptor (EGFR) genotyping is now standard in the management of advanced lung adenocarcinoma, as this biomarker predicts marked benefit from treatment with EGFR tyrosine kinase inhibitors (TKI). EGFR exon 19 insertions are a poorly described family of EGFR mutations, and their association with EGFR-TKI sensitivity in lung adenocarcinoma is uncertain.
  
  
  METHODS
  Patients with lung cancers harboring EGFR exon 19 insertions were studied. The predicted effects of the insertions on the structure of the EGFR protein were examined, and EGFR exon 19 insertions were introduced into Ba/F3 cells to assess oncogenicity and in vitro sensitivity to EGFR-TKIs. In patients receiving TKI, response magnitude was assessed with serial computed tomographic (CT) measurement.
  
  
  RESULTS
  Twelve tumors harboring EGFR exon 19 insertions were identified; patients were predominately female (92%) and never-smokers (75%). The 11 specimens available for full sequencing all showed an 18-bp insertion that resulted in the substitution of a Pro for Leu at residue 747. The mutant EGFR transformed the Ba/F3 cells, which were then sensitive to EGFR-TKI. Six patients with measurable disease received TKI and five had a response on serial CT.
  
  
  CONCLUSIONS
  EGFR exon 19 insertions are a newly appreciated family of EGFR-TKI-sensitizing mutations, and patients with tumors harboring these mutations should be treated with EGFR-TKI. While these mutations may be missed through the use of some mutation-specific assays, the addition of PCR product size analysis to multigene assays allows sensitive detection of both exon 19 insertion and deletion mutations.
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Mai
authors.initials: M
authors.lastname: He
authors.forename: Marzia
authors.initials: M
authors.lastname: Capelletti
authors.forename: Khedoudja
authors.initials: K
authors.lastname: Nafa
authors.forename: Cai-Hong
authors.initials: CH
authors.lastname: Yun
authors.forename: Maria E
authors.initials: ME
authors.lastname: Arcila
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Miller
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Ginsberg
authors.forename: Binsheng
authors.initials: B
authors.lastname: Zhao
authors.forename: Mark G
authors.initials: MG
authors.lastname: Kris
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eck
authors.forename: Pasi A
authors.initials: PA
authors.lastname: Jänne
authors.forename: Marc
authors.initials: M
authors.lastname: Ladanyi
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Oxnard
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000077716:Afatinib; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D045744:Cell Line, Tumor; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics*; D005091:Exons; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D016254:Mutagenesis, Insertional; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D017384:Sequence Deletion
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000077716:Afatinib; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib