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Rational, biologically based treatment of EGFR-mutant non-small-cell lung cancer
Open accessAbstract
Epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) was first recognized in 2004 as a distinct, clinically relevant molecular subset of lung cancer. The disease has been the subject of intensive research at both the basic scientific and clinical levels, becoming a paradigm for how to understand and treat oncogene-driven carcinomas. Although patients with EGFR-mutant tumours have increased sensitivity to tyrosine kinase inhibitors (TKIs), primary and acquired resistance to these agents remains a major clinical problem. This Review summarizes recent developments aimed at treating and ultimately curing the disease.
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“The third-generation drug retains the acrylamide group and covalently binds to Cys797, but replaces the quinazoline portion of the first- and second-generation compounds with pyrimidine to promote selectivity for T790M, showing a higher affinity for T790M than WT-EGFR.119”
From Recent advances in targeting the “undruggable” proteins: from drug discovery to clinical trials (2023) · cites this paper as [119]
In the citing paper
“Mutations in EGFR occur in 10-35% of NSCLCs and confer sensitivity to the EGFR TKIs erlotinib, gefitinib, and afatinib (6).”
From AZD9291, an Irreversible EGFR TKI, Overcomes T790M-Mediated Resistance to EGFR Inhibitors in Lung Cancer (2014) · cites this paper as [6]
In the citing paper
“Exon 20 insertion mutations comprise 4–10% of all EGFR mutations 27,29–32.”
From Structural, Biochemical, and Clinical Characterization of Epidermal Growth Factor Receptor (EGFR) Exon 20 Insertion Mutations in Lung Cancer (2013) · cites this paper as [30]
In the citing paper
“Indeed, while ERBB2 gene amplifications and gain-of-function EGFR mutations support the proliferation of various cancer cell types (Oh and Bang, 2020; Pao and Chmielecki, 2010), VEGFA is critical for tumor-driven neoangiogenesis (Apte et al., 2019) and TGFb promotes the establishment of a fibrotic microenvironment that is poorly permissive to access by therapeutics (Derynck et al., 2020).”
From Immunomodulation by targeted anticancer agents (2021) · cites this paper as Pao and Chmielecki, 2010
In the citing paper
“Over the past two decades, a number of mAbs and TKIs have been developed to target these proteins or their binding partners, and some of these molecules, including HER2-, EGFR-, and VEGFA-specific agents, have been licensed for use in a variety of oncological indications (Apte et al., 2019; Oh and Bang, 2020; Pao and Chmielecki, 2010).”
From Immunomodulation by targeted anticancer agents (2021) · cites this paper as Pao and Chmielecki, 2010
In the citing paper
“EGFR mutations are primarily localized within two hot spots of the kinase domains, a series of overlapping deletions in exon 19 and a leucine to arginine substitution at amino acid position 858 (L858R) [reviewed in (Pao and Chmielecki, 2010)].”
From ERBB Receptors: From Oncogene Discovery to Basic Science to Mechanism-Based Cancer Therapeutics (2014) · cites this paper as Pao and Chmielecki, 2010
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“EGFR mutations are usually heterozygous, with the mutant allele also showing gene amplificatio”
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“To minimize reporting of false-positive and false-negative activity in clinical trials and to facilitate the identification of agents that truly overcome acquired resistance to gefitinib and erlotinib, the following clinical and molecular criteria were recently proposed to more precisely define acquired resistance to…”
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“A small proportion (1–20%, depending on the trial) of patients with no detectable EGFR -activating mutations show a radiographic response when treated with EGFR TKI”
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“It has also shown efficacy against H1975 (EGFR L858R and T790M) cells and xenograft model”
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“( Table 1 ), the major clinical characteristics of responding patients were found to be adenocarcinoma histology, East Asian ethnicity, a history of never smoking cigarettes and female gende”
BackgroundSelf-citationEpidermal Growth Factor Receptor Targeting in Cancer
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“Cetuximab is a human–murine chimeric IgG1 monoclonal antibody that binds to the extracellular domain of EGFR and blocks EGFR signallin”
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Oncogenic Transformation by Inhibitor-Sensitive and -Resistant EGFR Mutants
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“In vitro studies have shown that such mutations are less sensitive to EGFR TKIs than the exon 19 deletion and L858R mutant”
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Structural Basis for the Autoinhibition and STI-571 Inhibition of c-Kit Tyrosine Kinase
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Antitumor Activity of HKI-272, an Orally Active, Irreversible Inhibitor of the HER-2 Tyrosine Kinase
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Inhibition of drug-resistant mutants of ABL, KIT, and EGF receptor kinases
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“Second-generation EGFR inhibitors were touted to overcome T790M-mediated resistanc”
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“This variant seems to be associated with increased genetic susceptibility to lung cancer, which usually occurs after the age of 50 (Ref”
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“Increased IGF1R signalling has also been associated with acquired resistance, albeit only in an in vitro model using a cell line that expressed high levels of wild-type EGF”
BackgroundAlbanell, J., Rojo, F., Averbuch, S., Feyereislova, A., Mascaro, J. M., Herbst, R. S., LoRusso, P. M., Rischin, D., Sauleda, S., Gee, J., et al. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.20.1.110 · Cited by 523
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“L747 occurs at the start of the loop between the β3 strand and the α-C helix and is thought to shift theequilibrium towards the active conformation of the recepto”
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“Similarly, loss of PTEN expression in EGFR -mutant cells correlates with decreased sensitivity to EGFR TKI”
BackgroundPoliti, K., Zakowski, M. F., Fan, P.-D., Schonfeld, E. A., Pao, W., & Varmus, H. E. (2006) · Genes & Development · doi:10.1101/gad.1417406 · Cited by 478
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“Interestingly, in mouse models of lung cancer driven by EGFR-L858R (exon 21), cetuximab can induce dramatic tumour regression”
BackgroundEngelman, J. A., Mukohara, T., Zejnullahu, K., Lifshits, E., Borras, A. M., Gale, C.-M., Naumov, G. N., Yeap, B. Y., Jarrell, E., Sun, J., et al. (2006) · Journal of Clinical Investigation · doi:10.1172/jci28656 · Cited by 457 · cited 1×
“The addition of a constitutively active PI3K mutant (E545K) has been shown to confer gefitinib resistance, at least in vitro”
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“The crystal structures of the L858R and G719S TKI-sensitive EGFR mutants show that these substitutions activate the kinase through disruption of autoinhibitory interactions, resulting in receptors with 50-fold more activity compared with their wild-type counterpart”
BackgroundSequist, L. V. D., Besse, B., Lynch, T. J., Miller, V. A., Wong, K., Gitlitz, B. J., Eaton, K. D., Zacharchuk, C., Freyman, A., Powell, C., et al. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.27.9414 · Cited by 437
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“In the past 5 years, however, at least nine prospective single-arm studies for patients with advanced NSCLC and activating EGFR mutations have validated the benefit of EGFR TKIs in EGFR -mutant lung cancer (reviewed in Ref”
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“Interestingly, in mouse models of lung cancer driven by EGFR-L858R (exon 21), cetuximab can induce dramatic tumour regression”
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“When tumours relapse, a common mechanism of resistance is the emergence of second-site mutations in ABL and KIT”
BackgroundThe Juxtamembrane Region of the EGF Receptor Functions as an Activation Domain
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“As MECs harbour a recurrent mucoepidermoid carcinoma translocated 1 ( MECT1 )–mastermind-like 2( MAML2 )fusio”
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“For example, small insertions or duplications in exon 20 (such as D770_N771, ins NPG, ins SVQ, insG and N771T; see Ref”
BackgroundEML4-ALK: Honing In on a New Target in Non–Small-Cell Lung Cancer
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“Multiple different EML4–ALK variants have been identified, but all involve the tyrosine kinase portion of ALK and have variable lengths of EML4 (Ref”
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Structure and Clinical Relevance of the Epidermal Growth Factor Receptor in Human Cancer
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“D761 occurs in the α-C helix and a salt bridge formed by D761 may be disrupted by mutation to tyrosine, affecting the catalytic cleft of the recepto”
BackgroundStructural biology contributions to the discovery of drugs to treat chronic myelogenous leukaemia
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“but no responses were reported in a Phase I trial involving 14 patients with NSCLC with EGFR-positive tumours (measured by IHC) and six patients who had previously progressed on erlotinib achieved stable diseas”
BackgroundMiller, V. A., Riely, G. J., Zakowski, M. F., Li, A. R., Patel, J. D., Heelan, R. T., Kris, M. G., Sandler, A. B., Carbone, D. P., Tsao, A. S., et al. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.13.0062 · Cited by 298 · cited 1×
“Erlotinib has similarly been shown to be highly effective in patients with EGFR -mutant tumour”
BackgroundSelf-citationRiely, G. J., Kris, M. G., Zhao, B., Akhurst, T. J., Milton, D. T., Moore, E., Tyson, L. B., Pao, W. J., Rizvi, N. A., Schwartz, L. H., et al. (2007) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-07-0560 · Cited by 290 · cited 1×
“Following the discontinuation of TKI therapy, disease flares have also been reporte”
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Self-citationPIK3CA mutation status in Japanese lung cancer patients
Kawano, O., Sasaki, H., Endo, K., Suzuki, E., Haneda, H., Yukiue, H., Kobayashi, Y., Yano, M., & Fujii, Y. (2006) · Lung Cancer · doi:10.1016/j.lungcan.2006.07.006 · Cited by 280 · cited 1×
“For example, mutations in PIK3CA , the p110α catalytic subunit of PI3K, are found in approximately 2% of NSCLCs and can co-occur with EGFR mutation”
BackgroundMissense mutations of the BRAF gene in human lung adenocarcinoma.
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“The epithelial to mesenchymal transition (EMT) has been associated with resistance to EGFR TKIs in vitro”
BackgroundHirsch, F. R., Varella‐Garcia, M., Cappuzzo, F., McCoy, J., Bemis, L., Xavier, A. C., Dziadziuszko, R., Gumerlock, P. H., Chansky, K., West, H., et al. (2007) · Annals of Oncology · doi:10.1093/annonc/mdm003 · Cited by 270
Prognostic and Therapeutic Implications of EGFR and KRAS Mutations in Resected Lung Adenocarcinoma
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“EGFR -mutant tumours most often display adenocarcinoma histology and are associated with a better prognosis than EGFR wild-type tumour”
BackgroundSelf-citationKhambata‐Ford, S., Harbison, C. T., Hart, L. L., Awad, M., Xu, L., Horak, C. E., Dakhil, S. R., Hermann, R. C., Lynch, T. J., & Weber, M. R. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.25.2890 · Cited by 265 · cited 1×
“No links between EGFR mutations and sensitivity to cetuximab have been found, although only a limited number of patients has been studie”
BackgroundJackman, D. M., Holmes, A. J., Lindeman, N., Wen, P. Y., Kesari, S., Borras, A. M., Bailey, C., de Jong, F., Jänne, P. A., & Johnson, B. E. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.06.6126 · Cited by 260 · cited 1×
“This observation may be due to a lack of selective pressure, as the concentration of EGFR TKI that reaches the brain is 100-fold less than that found in bloo”
BackgroundRosell, R., Robinet, G., Szczęsna, A., Ramlau, R., Constenla, M., Mennecier, B., Pfeifer, W., O'Byrne, K. J., Welte, T., Kolb, R., et al. (2007) · Annals of Oncology · doi:10.1093/annonc/mdm474 · Cited by 258 · cited 1×
“and, despite cetuximab showing a promising additive effect with chemotherap”
BackgroundEGFR Mutations in Small-Cell Lung Cancers in Patients Who Have Never Smoked
Zakowski, M. F., Ladanyi, M., & Kris, M. G. (2006) · New England Journal of Medicine · doi:10.1056/nejmc053610 · Cited by 254
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“Clinically, the prognostic value of the EGFR mutation in patients undergoing surgery is approximately the same in Japan and the United State”
BackgroundGenetic Predictors of MEK Dependence in Non–Small Cell Lung Cancer
Pratilas, C. A., Hanrahan, A. J., Halilovic, E., Persaud, Y., Soh, J., Chitale, D. A., Shigematsu, H., Yamamoto, H., Sawai, A., Janakiraman, M., et al. (2008) · Cancer Research · doi:10.1158/0008-5472.can-08-2223 · Cited by 252 · cited 1×
“gov/drugdictionary/?CdrID=456780">PD0325901 but are resistant to EGFR inhibitio”
BackgroundSelf-citationShah, N. P., Kim, D.-W., Kantarjian, H. M., Rousselot, P. H., Llacer, P. E. D., Enrico, A. I., Vela‐Ojeda, J., Silver, R. T., Khoury, H. J., Muller, M. C., et al. (2010) · Haematologica · doi:10.3324/haematol.2009.011452 · Cited by 245 · cited 1×
“gov/drugdictionary/?CdrID=315885">dasatinib (Sprycel; Bristol–Myers Squibb) induced similar killing rates as chronic exposur”
BackgroundLi, D., Shimamura, T., Ji, H., Chen, L., Haringsma, H. J., McNamara, K. L., Liang, M., Perera, S. A., Zaghlul, S., Borgman, C. L., et al. (2007) · Cancer Cell · doi:10.1016/j.ccr.2007.06.005 · Cited by 243 · cited 1×
“gov/drugdictionary/?CdrID=42555">rapamycin resulted in greater tumour shrinkage than either agent alone in transgenic mice with T790M-containing lung tumour”
BackgroundYang, C.-H., Yu, C., Shih, J., Chang, Y., Hu, F., Tsai, M.-C., Chen, K., Lin, Z., Huang, C.-J., Shun, C., et al. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.15.6695 · Cited by 238 · cited 1×
“A small proportion (1–20%, depending on the trial) of patients with no detectable EGFR -activating mutations show a radiographic response when treated with EGFR TKI”
BackgroundSelf-citationHaura, E. B., Ricart, A. D., Larson, T. G., Stella, P. J., Bazhenova, L., Miller, V. A., Cohen, R. B., Eisenberg, P. D., Selaru, P., Wilner, K. D., et al. (2010) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-09-1920 · Cited by 237 · cited 1×
“A Phase II MEK inhibitor trial with PD0325901 showed little efficacy in advanced NSCLC; however, patients were not preselected by mutation statu”
MethodAmplification of EGFR T790M causes resistance to an irreversible EGFR inhibitor
Ercan, D., Zejnullahu, K., Yonesaka, K., Xiao, Y., Capelletti, M., Rogers, A. M., Lifshits, E., Brown, A., Lee, C., Christensen, J. G., et al. (2010) · Oncogene · doi:10.1038/onc.2009.526 · Cited by 235 · cited 1×
“In vitro , gefitinib-resistant cells already harbouring T790M further amplify the T790M allele on exposure to PF-0299804 (Ref”
BackgroundAn integrated genomic analysis of lung cancer reveals loss of DUSP4 in EGFR-mutant tumors
Chitale, D. A., Gong, Y., Taylor, B. S., Broderick, S., Brennan, C., Somwar, R., Golas, B., Wang, L., Motoi, N., Szőke, J., et al. (2009) · Oncogene · doi:10.1038/onc.2009.135 · Cited by 232 · cited 1×
“Multiple genomic studies have shown that EGFR -mutant NSCLCs represent distinct disease phenotypes that have unique expression, mutation and copy number signature”
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“EGFR mutations are usually heterozygous, with the mutant allele also showing gene amplificatio”
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BackgroundSequential occurrence of non-small cell and small cell lung cancer with the same EGFR mutation
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“, multiple re-responses to EGFR TKIs following a short hiatus without targeted therapy have been reporte”
BackgroundEGFR-T790M Is a Rare Lung Cancer Susceptibility Allele with Enhanced Kinase Activity
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BackgroundSelf-citation
Flagged first, then by citations
Research works printed but not linked: 1
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“Mutations in EGFR occur in 10% to 35% of NSCLCs and confer sensitivity to the EGFR TKIs erlotinib, gefitinib, and afatinib (6).”
InfluentialSelf-citationMapping the Hallmarks of Lung Adenocarcinoma with Massively Parallel Sequencing
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BackgroundSelf-citationIntegrative genome analyses identify key somatic driver mutations of small-cell lung cancer
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Self-citation
Metadata
- Authors
- Pao, W., & Chmielecki, J.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Pao, William
- Venue
- Nature Reviews Cancer
- Published
- 2010-10-22
- Volume
- 10
- Issue
- 11
- Pages
- 760-774
- ISSN
- 1474-175X (ISSN-L)
- 1474-1768
- PMC
- PMC3072803
- OpenAlex
- W2090029719
- Cited by
- 1,083
- References
- 180
- Citations by year
- 2026: 24 · 2025: 43 · 2024: 54 · 2023: 49 · 2022: 45 · 2021: 65 · 2020: 79 · 2019: 56 · 2018: 69 · 2017: 72 · 2016: 90 · 2015: 82 · 2014: 93 · 2013: 93 · 2012: 104
- FWCI
- 14.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature reviews. Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Vanderbilt University
- National Institutes of Health
- University of California, San Francisco
- National Cancer Institute (P30 CA 68485, R01CA121210, P01CA129243, CA90949, U54CA143798, P50CA090949, P30CA068485)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
- Keywords
- EGFR-mutant non-small cell lung cancer, epidermal growth factor receptor, tyrosine kinase inhibitors, gefitinib, erlotinib, acquired drug resistance, primary resistance, targeted therapy
- MeSH terms
- Antineoplastic Agents, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Mutation, Protein-Tyrosine Kinases, Drug Resistance, Neoplasm, Protein Kinase Inhibitors, ErbB Receptors
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