Molecular Mechanism of EGFR-TKI Resistance in EGFR-Mutated Non-Small Cell Lung Cancer: Application to Biological Diagnostic and Monitoring

Damien Reita (1, 2) , Lucile Pabst (2) , Erwan Pencreach (3, 2) , Eric Guérin (3, 2) , Laurent Dano (2) , Valérie Rimelen (2) , Anne-Claire Voegeli (2) , Laurent Vallat (2) , Céline Mascaux (3, 2) , Michèle Beau-Faller (3, 2)

1 LBP - Laboratoire de Bioimagerie et Pathologies
2 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
3 IRFAC - Inserm U1113 - Interface de Recherche Fondamentale et Appliquée en Cancérologie

Non-small cell lung cancer (NSCLC) is the most common cancer in the world. Activating epidermal growth factor receptor (EGFR) gene mutations are a positive predictive factor for EGFR tyrosine kinase inhibitors (TKIs). For common EGFR mutations (Del19, L858R), the standard first-line treatment is actually third-generation TKI, osimertinib. In the case of first-line treatment by first (erlotinib, gefitinib)- or second-generation (afatinib) TKIs, osimertinib is approved in second-line treatment for patients with T790M EGFR mutation. Despite the excellent disease control results with EGFR TKIs, acquired resistance inevitably occurs and remains a biological challenge. This leads to the discovery of novel biomarkers and possible drug targets, which vary among the generation/line of EGFR TKIs. Besides EGFR second/third mutations, alternative mechanisms could be involved, such as gene amplification or gene fusion, which could be detected by different molecular techniques on different types of biological samples. Histological transformation is another mechanism of resistance with some biological predictive factors that needs tumor biopsy. The place of liquid biopsy also depends on the generation/line of EGFR TKIs and should be a good candidate for molecular monitoring. This article is based on the literature and proposes actual and future directions in clinical and translational research.

Mots clés: EGFR mutations; non-small cell lung cancer; tyrosine kinase inhibitors; resistance mechanisms; molecular analysis; next-generation sequencing; cell-free DNA

Domaines: Cancer; Pneumologie et système respiratoire; Génomique, Transcriptomique et Protéomique [q-bio.GN]

Damien Reita, Lucile Pabst, Erwan Pencreach, Eric Guérin, Laurent Dano, et al.. Molecular Mechanism of EGFR-TKI Resistance in EGFR-Mutated Non-Small Cell Lung Cancer: Application to Biological Diagnostic and Monitoring. Cancers, 2021, 13 (19), pp.4926. ⟨10.3390/cancers13194926⟩. ⟨hal-03881957⟩