HER2 Amplification: A Potential Mechanism of Acquired Resistance to EGFR Inhibition in EGFR -Mutant Lung Cancers That Lack the Second-Site EGFR T790M Mutation
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Abstract
Abstract EGF receptor (EGFR)–mutant lung cancers eventually become resistant to treatment with EGFR tyrosine kinase inhibitors (TKI). The combination of EGFR-TKI afatinib and anti-EGFR antibody cetuximab can overcome acquired resistance in mouse models and human patients. Because afatinib is also a potent HER2 inhibitor, we investigated the role of HER2 in EGFR-mutant tumor cells. We show in vitro and in vivo that afatinib plus cetuximab significantly inhibits HER2 phosphorylation. HER2 overexpression or knockdown confers resistance or sensitivity, respectively, in all studied cell line models. FISH analysis revealed that HER2 was amplified in 12% of tumors with acquired resistance versus only 1% of untreated lung adenocarcinomas. Notably, HER2 amplification and EGFRT790M were mutually exclusive. Collectively, these results reveal a previously unrecognized mechanism of resistance to EGFR-TKIs and provide a rationale to assess the status and possibly target HER2 in EGFR-mutant tumors with acquired resistance to EGFR-TKIs. Significance: Because all EGFR-mutant lung adenocarcinomas eventually develop resistance to TKI therapy, understanding mechanisms of acquired resistance may improve clinical outcomes. These results implicate HER2 as a novel protein involved in the sensitivity or resistance of EGFR-mutant lung cancer and provide a rationale to assess the status of and possibly target HER2 in such tumors. Cancer Discov; 2(10); 922–33. ©2012 AACR. Read the Commentary on this article by Blakely and Bivona, p. 872. This article is highlighted in the In This Issue feature, p. 857.
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In a subset of EGFR mutant lung cancers, amplification of HER2, presumably involving HER3 reactivation, was identified as a resistance mechanism to EGFR TKIs.
“In a subset of EGFR mutant lung cancers, amplification of HER2, presumably involving HER3 reactivation, was also identified as a resistance mechanism to EGFR TKIs (Takezawa et al., 2012).”
From ERBB Receptors: From Oncogene Discovery to Basic Science to Mechanism-Based Cancer Therapeutics (2014) · cites this paper as Takezawa et al., 2012
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- Authors
- Takezawa, K., Pirazzoli, V., Arcila, M. E., Nebhan, C. A., Song, X., de Stanchina, E., Ohashi, K., Janjigian, Y. Y., Spitzler, P. J., Melnick, M. A., Riely, G. J., Kris, M. G., Miller, V. A., Ladanyi, M., Politi, K., & Pao, W.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Authors' Affiliations: 1Department of Medicine, Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; 2Department of Pathology and Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut; 3Antitumor Assessment Core, Molecular Pharmacology and Chemistry Program, 4Department of Medicine, Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, and 5Molecular Diagnostics Service, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
- Corresponding author
- Pao, William
- ORCID
- Venue
- Cancer Discovery
- Published
- 2012-10-01
- Volume
- 2
- Issue
- 10
- Pages
- 922-933
- ISSN
- 2159-8274 (ISSN-L)
- 2159-8290
- PMC
- PMC3473100
- OpenAlex
- W2143913849
- Cited by
- 710
- References
- 37
- Citations by year
- 2026: 19 · 2025: 24 · 2024: 27 · 2023: 37 · 2022: 32 · 2021: 53 · 2020: 71 · 2019: 59 · 2018: 81 · 2017: 65 · 2016: 62 · 2015: 74 · 2014: 60 · 2013: 39 · 2012: 6
- FWCI
- 45.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer Discovery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (R01CA121210, P01CA129243, R01CA120247, U54CA143798, R00CA131488, P30CA068485)
- National Institute of General Medical Sciences (T32GM007347)
- 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
- HER2 amplification, acquired drug resistance, EGFR tyrosine kinase inhibitors, EGFR-mutant lung adenocarcinoma, afatinib, cetuximab, T790M mutation, HER2 overexpression, combination therapy, HER2 phosphorylation
- MeSH terms
- Cetuximab, Erlotinib Hydrochloride, Adenocarcinoma of Lung, Afatinib, Adenocarcinoma, Animals, Antibodies, Monoclonal, Antineoplastic Agents, Humans, Lung Neoplasms, Mice, Nude, Mutation, Phosphorylation, Quinazolines, Erb-b2 Receptor Tyrosine Kinases, Drug Resistance, Neoplasm, Phosphatidylinositol 3-Kinases, RNA Interference, RNA, Small Interfering, Cell Line, Tumor, Protein Kinase Inhibitors, Mice, Class I Phosphatidylinositol 3-Kinases, Molecular Targeted Therapy, Antibodies, Monoclonal, Humanized, ErbB Receptors
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