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    Association details:
    Biomarker:EGFR T790M
    Cancer:Lung Adenocarcinoma
    Drug:erlotinib (EGFR inhibitor)
    Direction:Sensitive
    Evidence:
    Evidence Level:
    Sensitive: B - Late Trials
    New
    Source:
    J Clin Oncol
    Title:

    Randomized Phase III Study Comparing Gefitinib With Erlotinib in Patients With Previously Treated Advanced Lung Adenocarcinoma: WJOG 5108L

    Excerpt:
    Several patients displayed uncommon mutations or double mutations including T790M…In the subgroup with uncommon mutations (n = 25), median PFS, RR, and DCR for gefitinib versus erlotinib were 6.4 and 5.3 months (HR, 1.109; 95% CI, 0.464 to 2.653; P = .815), 25.0% and 42.9% (P = .419), and 66.7% and 71.4% (P = .829), respectively.
    DOI:
    10.1200/JCO.2015.63.4154
    Evidence Level:
    Sensitive: C2 – Inclusion Criteria
    New
    Source:
    clinicaltrials.gov
    Title:

    Trial of Ruxolitinib and Erlotinib in Patients With EGFR-mutant Lung Adenocarcinoma With Acquired Resistance to Erlotinib

    Excerpt:
    ...- Must have undergone biopsy after development of acquired resistance to erlotinib (which is performed as standard of care) with adequate tissue to determine EGFR T790M and tumor histology....
    Trial ID:
    NCT02155465
    Evidence Level:
    Sensitive: C3 – Early Trials
    Source:
    IASLC-WCLC 2021
    Title:

    Metastatic NSCLC -Re-Challenging With Fist Generation TKI After a Drug Free Holiday After Resistance to 3rd Generation TKI

    Published date:
    08/18/2021
    Excerpt:
    20 patients of metastatic adenocarcinoma...Osimertinib was offered to those who developed EGFR TKI resistance due to T790M mutation (10 cases)....All patients were given 3 months drug free holiday & then re-challenged with Erlotinib....4 out of 10 (40%) patients responded to the therapy.
    Evidence Level:
    Sensitive: C4 – Case Studies
    Source:
    J Int Med Res
    Title:

    Histological transformation of lung adenocarcinoma to small cell lung cancer with mutant C797S conferring acquired resistance to osimertinib

    Published date:
    06/30/2020
    Excerpt:
    CONTRADICTING EVIDENCE: A man with recurrent lung adenocarcinoma harboring an EGFR exon 19 deletion received erlotinib for 10 months following curative surgery and adjuvant chemotherapy...However, he switched to osimertinib after repeat biopsy showed EGFR exon 19 deletion and T790M mutation leading to erlotinib resistance...His disease progressed after 15 months and repeat biopsy showed SCLC. Next-generation sequencing of peripheral blood detected EGFR exon 19 deletion, T790M mutation, cis-C797S mutation, and RB1 inactivation.
    DOI:
    https://doi.org/10.1177/0300060520927918