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Overcoming EGFR(G724S)-mediated osimertinib resistance through unique binding characteristics of second-generation EGFR inhibitors

The emergence of acquired resistance against targeted drugs remains a major clinical challenge in lung adenocarcinoma patients. In a subgroup of these patients we identified an association between selection of EGFR(T790M)-negative but EGFR(G724S)-positive subclones and osimertinib resistance. We dem...

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Detalles Bibliográficos
Autores principales: Fassunke, Jana, Müller, Fabienne, Keul, Marina, Michels, Sebastian, Dammert, Marcel A., Schmitt, Anna, Plenker, Dennis, Lategahn, Jonas, Heydt, Carina, Brägelmann, Johannes, Tumbrink, Hannah L., Alber, Yannic, Klein, Sebastian, Heimsoeth, Alena, Dahmen, Ilona, Fischer, Rieke N., Scheffler, Matthias, Ihle, Michaela A., Priesner, Vanessa, Scheel, Andreas H., Wagener, Svenja, Kron, Anna, Frank, Konrad, Garbert, Katia, Persigehl, Thorsten, Püsken, Michael, Haneder, Stefan, Schaaf, Bernhard, Rodermann, Ernst, Engel-Riedel, Walburga, Felip, Enriqueta, Smit, Egbert F., Merkelbach-Bruse, Sabine, Reinhardt, H. Christian, Kast, Stefan M., Wolf, Jürgen, Rauh, Daniel, Büttner, Reinhard, Sos, Martin L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220297/
https://www.ncbi.nlm.nih.gov/pubmed/30405134
http://dx.doi.org/10.1038/s41467-018-07078-0
Descripción
Sumario:The emergence of acquired resistance against targeted drugs remains a major clinical challenge in lung adenocarcinoma patients. In a subgroup of these patients we identified an association between selection of EGFR(T790M)-negative but EGFR(G724S)-positive subclones and osimertinib resistance. We demonstrate that EGFR(G724S) limits the activity of third-generation EGFR inhibitors both in vitro and in vivo. Structural analyses and computational modeling indicate that EGFR(G724S) mutations may induce a conformation of the glycine-rich loop, which is incompatible with the binding of third-generation TKIs. Systematic inhibitor screening and in-depth kinetic profiling validate these findings and show that second-generation EGFR inhibitors retain kinase affinity and overcome EGFR(G724S)-mediated resistance. In the case of afatinib this profile translates into a robust reduction of colony formation and tumor growth of EGFR(G724S)-driven cells. Our data provide a mechanistic basis for the osimertinib-induced selection of EGFR(G724S)-mutant clones and a rationale to treat these patients with clinically approved second-generation EGFR inhibitors.