title: Oncogene swap as a novel mechanism of acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitor in lung cancer.
abstract: Mutant selective epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), such as rociletinib and AZD9291, are effective for tumors with T790M secondary mutation that become refractory to first-generation EGFR-TKI. However, acquired resistance to these prospective drugs is anticipated considering the high adaptability of cancer cells and the mechanisms remain largely obscure. Here, CNX-2006 (tool compound of rociletinib) resistant sublines were established by chronic exposure of HCC827EPR cells harboring exon 19 deletion and T790M to CNX-2006. Through the analyses of these resistant subclones, we identified two resistant mechanisms accompanied by MET amplification. One was bypass signaling by MET amplification in addition to T790M, which was inhibited by the combination of CNX-2006 and MET-TKI. Another was loss of amplified EGFR mutant allele including T790M while acquiring MET amplification. Interestingly, MET-TKI alone was able to overcome this resistance, suggesting that oncogenic dependence completely shifted from EGFR to MET. We propose describing this phenomenon as an "oncogene swap." Furthermore, we analyzed multiple lesions from a patient who died of acquired resistance to gefitinib, then found a clinical example of an oncogene swap in which the EGFR mutation was lost and a MET gene copy was gained. In conclusion, an "oncogene swap" from EGFR to MET is a novel resistant mechanism to the EGFR-TKI. This novel mechanism should be considered in order to avoid futile inhibition of the original oncogene.
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Hiroshi
authors: H
authors: Mizuuchi
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Kenichi
authors: K
authors: Suda
authors: Department of Respiratory Medicine, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan.
authors: Isao
authors: I
authors: Murakami
authors: Department of Genome Biology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Kazuko
authors: K
authors: Sakai
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Katsuaki
authors: K
authors: Sato
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Yoshihisa
authors: Y
authors: Kobayashi
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Masaki
authors: M
authors: Shimoji
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Masato
authors: M
authors: Chiba
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Yuichi
authors: Y
authors: Sesumi
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Kenji
authors: K
authors: Tomizawa
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Toshiki
authors: T
authors: Takemoto
authors: Division of Molecular Oncology, Aichi Cancer Center Research Institute, Nagoya, Japan.
authors: Yoshitaka
authors: Y
authors: Sekido
authors: Department of Genome Biology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Kazuto
authors: K
authors: Nishio
authors: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors: Tetsuya
authors: T
authors: Mitsudomi
mesh_terms: D000178:Acrylamides / Q000008:administration & dosage; D045744:Cell Line, Tumor; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics*; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D009154:Mutation; D009857:Oncogenes; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D019859:Proto-Oncogene Proteins c-met / Q000235:genetics*; D011743:Pyrimidines / Q000008:administration & dosage; D011799:Quinazolines / Q000008:administration & dosage
chemical_list: D000178:Acrylamides; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011799:Quinazolines; C000589977:rociletinib; C512478:EGFR protein, human; D066246:ErbB Receptors; C491743:MET protein, human; D019859:Proto-Oncogene Proteins c-met; D000077156:Gefitinib
keywords: Acquired resistance; MET amplification; T790M; epidermal growth factor receptor-tyrosine kinase inhibitors; non-small cell lung cancer