Cited by 1,442Glioma Diagnosis and TreatmentHER2/EGFR in Cancer ResearchLung Cancer Treatments and Mutations

Molecular determinants of the response of glioblastomas to EGFR kinase inhibitors

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Mellinghoff, Ingo K., Wang, Maria Y., Vivanco, Igor, Haas-Kogan, Daphne A., Zhu, Shaojun, Dia, Ederlyn Q., Lu, Kan V., Yoshimoto, Koji +16 more·2005·New England Journal of Medicine

Abstract

BACKGROUND: The epidermal growth factor receptor (EGFR) is frequently amplified, overexpressed, or mutated in glioblastomas, but only 10 to 20 percent of patients have a response to EGFR kinase inhibitors. The mechanism of responsiveness of glioblastomas to these inhibitors is unknown. METHODS: We sequenced kinase domains in the EGFR and human EGFR type 2 (Her2/neu) genes and analyzed the expression of EGFR, EGFR deletion mutant variant III (EGFRvIII), and the tumor-suppressor protein PTEN in recurrent malignant gliomas from patients who had received EGFR kinase inhibitors. We determined the molecular correlates of clinical response, validated them in an independent data set, and identified effects of the molecular abnormalities in vitro. RESULTS: Of 49 patients with recurrent malignant glioma who were treated with EGFR kinase inhibitors, 9 had tumor shrinkage of at least 25 percent. Pretreatment tissue was available for molecular analysis from 26 patients, 7 of whom had had a response and 19 of whom had rapid progression during therapy. No mutations in EGFR or Her2/neu kinase domains were detected in the tumors. Coexpression of EGFRvIII and PTEN was significantly associated with a clinical response (P<0.001; odds ratio, 51; 95 percent confidence interval, 4 to 669). These findings were validated in 33 patients who received similar treatment for glioblastoma at a different institution (P=0.001; odds ratio, 40; 95 percent confidence interval, 3 to 468). In vitro, coexpression of EGFRvIII and PTEN sensitized glioblastoma cells to erlotinib. CONCLUSIONS: Coexpression of EGFRvIII and PTEN by glioblastoma cells is associated with responsiveness to EGFR kinase inhibitors.

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  • The EGFR inhibitors gefitinib and erlotinib have failed to demonstrate efficacy in GBM, largely as a consequence of persistent PI3K signaling due to PTEN loss and/or coactivation of other receptor tyrosine kinases.

    “Despite the compelling nature of EGFR as a drug target in GBM, the EGFR inhibitors gefitinib and erlotinib have failed to demonstrate efficacy (9–11), in large part as a consequence of persistent PI3K signaling due to PTEN loss and/or coactivation of other receptor tyrosine kinases (9, 10, 12).”

    From An LXR Agonist Promotes Glioblastoma Cell Death through Inhibition of an EGFR/AKT/SREBP-1/LDLR–Dependent Pathway (2011) · cites this paper as [9]

    The Abstract (page unavailable) reports that only 10–20% of patients respond to EGFR kinase inhibitors, but it also says a small subgroup benefits from gefitinib or erlotinib. The in vitro studies section (page unavailable) links PTEN loss to resistance, while noting both Akt-dependent and Akt-independent mechanisms. Our copy does not establish coactivation of other receptor tyrosine kinases as a cause of resistance, or show that persistent PI3K signaling largely explains the drugs’ limited efficacy. (LLM, conf=0.87)

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  • The U87, U87-EGFRvIII, U87-EGFR, U87-EGFR-PTEN, A431, LN229, T98, H1975 and HeLa cell lines have previously been reported.

    “These cell lines have previously been reported (9, 29).”

    From An LXR Agonist Promotes Glioblastoma Cell Death through Inhibition of an EGFR/AKT/SREBP-1/LDLR–Dependent Pathway (2011) · cites this paper as [9]

    The U87MG Model section (page unavailable) reports U87MG cells engineered to express EGFR or EGFRvIII, including PTEN-overexpressing cells. Other Cell-Line Models (page unavailable) reports A431 cells. Our copy does not report LN229, T98, H1975, or HeLa, so this source supports only part of the listed cell lines. (LLM, conf=0.88)

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  • Clinical evidence suggests that the presence of EGFRvIII can predict clinical responses of GBMs to the EGFR TKIs gefitinib and erlotinib.

    “There is clinical evidence suggesting that the presence of EGFRvIII can predict clinical responses of GBMs to the EGFR TKIs gefitinib and erlotinib (Haas-Kogan et al., 2005; Mellinghoff et al., 2005).”

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Research works printed but not linked: 3

  1. Choe G, Horvath S, Cloughesy TF, et al. Analysis of the phosphatidylinositol 3'- kinase signaling pathway in glioblastoma patients in vivo. Cancer Res 2003;63:2742-6.
  2. Batra SK, Castelino-Prabhu S, Wikstrand CJ, et al. Epidermal growth factor ligand- independent, unregulated, cell-transform- The New England Journal of Medicine Downloaded from nejm.org on August 29, 2023. For personal use only. No other uses without permission. Copyright © 2005 Massachusetts Medical Society. All rights reserved. n engl j med 353;19
  3. www.nejm.org november 10, 2005 2024 egfr kinase inhibitors for glioblastomas ing potential of a naturally occurring human mutant EGFRvIII gene. Cell Growth Differ 1995;6:1251-9.

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Authors
Mellinghoff, I. K., Wang, M. Y., Vivanco, I., Haas-Kogan, D. A., Zhu, S., Dia, E. Q., Lu, K. V., Yoshimoto, K., Huang, J. H. Y., Chute, D. J., Riggs, B. L., Horvath, S., Liau, L. M., Cavenee, W. K., Rao, P. N., Beroukhim, R., Peck, T. C., Lee, J. C., Sellers, W. R., Stokoe, D., Prados, M., Cloughesy, T. F., Sawyers, C. L., & Mischel, P. S.
Affiliations
  • University of California, Los Angeles (US)
  • Institute of Molecular Biology (BG)
  • University of California, San Francisco (US)
  • Harvard University (US)
  • Broad Institute (US)
  • Neurology, Inc (US)
  • Howard Hughes Medical Institute (US)
Venue
New England Journal of Medicine
Published
2005-11-10
Volume
353
Issue
19
Pages
2012-2024
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2070705072
Cited by
1,442
References
47
Citations by year
2026: 16 · 2025: 11 · 2024: 23 · 2023: 35 · 2022: 24 · 2021: 32 · 2020: 28 · 2019: 37 · 2018: 28 · 2017: 48 · 2016: 45 · 2015: 71 · 2014: 82 · 2013: 88 · 2012: 118
FWCI
49.56
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Accelerate Brain Cancer Cure
  • Ziering Family Foundation
  • National Institutes of Health (1k08ns043147-01, 5f31gm067600-02)
  • Genentech
  • University of California, San Francisco
  • National Cancer Institute (U01CA062399, CA097257, 5T32CA09056, R01CA108633, U01CA105695, CA 108633, CA 95616, CA 62399, CA105695, P01CA095616, T32CA009172, T32CA009056, P50CA097257)
  • National Institute of General Medical Sciences (5F31GM067600)
  • National Institute of Neurological Disorders and Stroke (NS43147, R01NS050151, NS 050151)
Topics
  • Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Keywords
glioblastoma, EGFR kinase inhibitors, EGFRvIII, PTEN, HER2/neu, erlotinib, recurrent malignant glioma, drug response, molecular determinants
MeSH terms
Erlotinib Hydrochloride, Gefitinib, Adult, Aged, Antineoplastic Agents, DNA, Neoplasm, Female, Gene Amplification, Glioblastoma, Humans, Male, Middle Aged, Mutation, Oligodendroglioma, Quinazolines, Signal Transduction, Gene Expression, Polymerase Chain Reaction, Gene Deletion, Sequence Analysis, DNA, Genes, erbB-2, Genes, erbB-1, Protein Kinase Inhibitors, PTEN Phosphohydrolase, ErbB Receptors

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