Cited by 381Lung Cancer Treatments and MutationsHER2/EGFR in Cancer ResearchCancer Genomics and Diagnostics

The DOI matches its Crossref record; 38 of the 40 references it cites were found in a registry or an index, and 2 are not checked yet; none of the 55 sources its claims cite is checked for support yet.

EGFR Mutations and Resistance to Irreversible Pyrimidine-Based EGFR Inhibitors

Open access

Published version of a preprint

Abstract

Purpose: Mutant selective irreversible pyrimidine-based EGFR kinase inhibitors, including WZ4002, CO-1686, and AZD9291, are effective in preclinical models and in lung cancer patients harboring the EGFR T790M gefitinib/erlotinib resistance mutation. However, little is known about how cancers develop acquired resistance to this class of EGFR inhibitors. We sought to identify and study EGFR mutations that confer resistance to this class of agents. Experimental Design: We performed an N-ethyl-N-nitrosourea (ENU) mutagenesis screen in EGFR-mutant (sensitizing alone or with concurrent EGFR T790M) Ba/F3 cells and selected drug-resistant clones. We evaluated the sensitivity of EGFR inhibitors in models harboring drug-resistant EGFR mutations. Results: We identified 3 major drug resistance mutations. EGFR L718Q, L844V, and C797S cause resistance to both WZ4002 and CO-1686 while, in contrast, only EGFR C797S leads to AZD9291 resistance. Cells containing an EGFR-sensitizing mutation, Del 19 or L858R, in conjunction with L718Q, L844V, or C797S retain sensitivity to quinazoline-based EGFR inhibitors, gefitinib and afatinib. The C797S mutation, in the presence of Del 19 or L858R and T790M, causes resistance to all current EGFR inhibitors, but L858R/T790M/C797S remains partially sensitive to cetuximab which leads to disruption of EGFR dimerization. Conclusions: Our findings provide insights into resistance mechanisms to irreversible pyrimidine-based EGFR inhibitors and identify specific genomic contexts in which sensitivity is retained to existing clinical EGFR inhibitors. These findings will guide the development of new strategies to inhibit EGFR. Clin Cancer Res; 21(17); 3913–23. ©2015 AACR. See related commentary by Ayeni et al., p. 3818

Checked 2026-10-06 · 2 references not checked yet

Overview

Integrity signals

Registry

Crossref · 10.1158/1078-0432.ccr-14-2789

Cites

38 of 40 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

58 Own result · 27 Not checked yet · 9 Own interpretation · 5 Own method

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Show all 56 claims

  • It may state two separate claims as one. 36
  • The quote only partly states this claim. 3
  • Probably not a substantial claim. 9
43 of 43
  • The paper relies on this without support.

    Most patients treated with an EGFR TKI will eventually develop disease progression.

    “However, the vast majority of patients will develop disease progression following successful treatment with an EGFR TKI.”
  • The paper relies on this without support.

    Afatinib's inhibition of wild-type EGFR causes toxicities that prevent dose escalation to levels needed to inhibit T790M.

    “Afatinib is a potent inhibitor of both mutant and wild type (WT) EGFR. Inhibition of WT EGFR leads to toxicities, including skin rash and diarrhea, which limits the ability to escalate afatinib doses in patients to those necessary to inhibit EGFR T790M.”
  • The paper relies on this without support.

    Secondary mutations in EGFR itself have not been described as a mechanism of acquired resistance.

    “Secondary mutations in EGFR itself have not been described as a mechanism of acquired resistance.”
  • The paper relies on this without support.

    Ba/F3 cell models with EGFR mutations are predictive of acquired resistance mechanisms that occur in human lung cancer.

    “Understanding the mechanism (s) of resistance to this class of agents may both help predict the mechanism(s) that will occur in patients and allow the development of subsequent treatment strategies.”
  • The authors state this as an assumption.

    The tertiary mutations L718Q, L844V, and C797S will also arise in patients treated with CO-1686 and AZD9291.

    “assuming these tertiary mutations will also arise in patients treated with CO-1686 and AZD9291.”
  • The paper relies on this without support.

    Acquired drug resistance limits the long-term clinical success of targeted therapies including EGFR inhibitors in patients with EGFR mutant NSCLC.

    “Acquired drug resistance limits the long term clinical success of targeted therapies including EGFR inhibitors in patients with EGFR mutant NSCLC.”
  • The paper relies on this without support.

    Acquired resistance will also develop to mutant-selective EGFR inhibitors including WZ4002, CO-1686, and AZD9291.

    “However, it is fully anticipated that acquired resistance will also develop to this class of EGFR inhibitors.”
7 of 7

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Metadata

Authors
Ercan, D., Choi, H. G., Yun, C.-H., Capelletti, M., Xie, T., Eck, M. J., Gray, N. S., & Jänne, P. A.
Affiliations
  • Dana-Farber Cancer Institute (US)
  • Harvard University (US)
  • 1Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
Corresponding author
Gray, Nathanael S.
Venue
Clinical Cancer Research
Published
2015-08-31
Volume
21
Issue
17
Pages
3913-3923
ISSN
  • 1078-0432 (ISSN-L)
  • 1557-3265
OpenAlex
W2126709309
Cited by
368
References
40
Citations by year
2026: 11 · 2025: 17 · 2024: 19 · 2023: 18 · 2022: 37 · 2021: 35 · 2020: 35 · 2019: 36 · 2018: 54 · 2017: 47 · 2016: 49 · 2015: 10
FWCI
42.71
Type
journal article
Language
en
Open access
Locations
  • Clinical Cancer Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R01CA114465, R01CA135257, P01CA154303)
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 mutation, acquired drug resistance, T790M mutation, EGFR C797S, L858R mutation, WZ4002, osimertinib, gefitinib, erlotinib, afatinib, cetuximab, EGFR dimerization, lung cancer, Ba/F3 cells
MeSH terms
Afatinib, Acrylamides, Animals, Codon, Humans, Models, Molecular, Molecular Conformation, Mutation, Pyrimidines, Quinazolines, Drug Resistance, Neoplasm, Amino Acid Substitution, Inhibitory Concentration 50, Cell Line, Tumor, Protein Kinase Inhibitors, Cell Proliferation, Mice, ErbB Receptors

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