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CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 43-45

Response to osimertinib in EGF816-resistant T790M-mutated lung cancer


Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

Correspondence Address:
Dr. James C Kuo
Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_3_18

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A 75-year-old male with metastatic adenocarcinoma of the lung that harbored an epidermal growth factor receptor (EGFR) mutation had disease control for 16 months with EGF816, an investigational, third-generation EGFR tyrosine kinase inhibitor (TKI), in a phase I clinical trial. On disease progression, his treatment was switched to an earlier third-generation EGFR TKI, osimertinib. A rapid response occurred but was short-lived for only 10 weeks, before a rapid progression ensued. The mechanism of sequential resistance to EGF816, and subsequently, osimertinib in this male was indeterminant because of the absence of baseline genomic profiling of the tumor. Repeated molecular profiling demonstrated persistent EGFR mutations and a possibly emergent TP53 G266E mutation. This case highlighted the importance of serial biopsies for genomic analysis to understand emergent TKI resistance. As non-cross resistance may be present among the various EGFR TKI, the potential in the sequential approach in targeted therapy should be explored.


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