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Overcoming EGFRG724S-mediated osimertinib resistance through unique binding characteristics of second-generation EGFR inhibitors.


ABSTRACT: 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 EGFRT790M-negative but EGFRG724S-positive subclones and osimertinib resistance. We demonstrate that EGFRG724S limits the activity of third-generation EGFR inhibitors both in vitro and in vivo. Structural analyses and computational modeling indicate that EGFRG724S 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 EGFRG724S-mediated resistance. In the case of afatinib this profile translates into a robust reduction of colony formation and tumor growth of EGFRG724S-driven cells. Our data provide a mechanistic basis for the osimertinib-induced selection of EGFRG724S-mutant clones and a rationale to treat these patients with clinically approved second-generation EGFR inhibitors.

SUBMITTER: Fassunke J 

PROVIDER: S-EPMC6220297 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Overcoming EGFR<sup>G724S</sup>-mediated osimertinib resistance through unique binding characteristics of second-generation EGFR inhibitors.

Fassunke Jana J   Müller Fabienne F   Keul Marina M   Michels Sebastian S   Dammert Marcel A MA   Schmitt Anna A   Plenker Dennis D   Lategahn Jonas J   Heydt Carina C   Brägelmann Johannes J   Tumbrink Hannah L HL   Alber Yannic Y   Klein Sebastian S   Heimsoeth Alena A   Dahmen Ilona I   Fischer Rieke N RN   Scheffler Matthias M   Ihle Michaela A MA   Priesner Vanessa V   Scheel Andreas H AH   Wagener Svenja S   Kron Anna A   Frank Konrad K   Garbert Katia K   Persigehl Thorsten T   Püsken Michael M   Haneder Stefan S   Schaaf Bernhard B   Rodermann Ernst E   Engel-Riedel Walburga W   Felip Enriqueta E   Smit Egbert F EF   Merkelbach-Bruse Sabine S   Reinhardt H Christian HC   Kast Stefan M SM   Wolf Jürgen J   Rauh Daniel D   Büttner Reinhard R   Sos Martin L ML  

Nature communications 20181107 1


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<sup>T790M</sup>-negative but EGFR<sup>G724S</sup>-positive subclones and osimertinib resistance. We demonstrate that EGFR<sup>G724S</sup> limits the activity of third-generation EGFR inhibitors both in vitro and in vivo. Structural analyses and computational modeling indicate that EGF  ...[more]

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