EGFR inhibition with afatinib or cetuximab in combination with RET TKIs was effective in addressing drug persistence. Consistently, knocking out EGFR or RET led to high sensitivity to RET or EGFR inhibitor respectively. Here, we have provided a comprehensive analysis of adaptive and acquired resistance against RET-rearranged NSCLC.
2 months ago
Journal
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RET (Ret Proto-Oncogene) • KIF5B (Kinesin Family Member 5B) • ERRFI1 (ERBB Receptor Feedback Inhibitor 1)
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RET fusion • RET mutation • ERRFI1 deletion • RET positive
In addition, this confirmed that MIG6 loss induces resistance to ROS1-TKIs in ROS1-positive cell lines. This study found a novel factor that plays a role in ALK and ROS1-TKI resistance by activating the EGFR pathway with low-dose ligands.
A MIG6 deletion was also found in a patient after progressing to ROS1 inhibition. Collectively, this study identifies MIG6 as a novel regulator for EGFR-mediated adaptive and acquired resistance to ALK/ROS1 inhibitors and suggests EGFR to MIG6 ratios and MIG6 damaging alterations as biomarkers to predict responsiveness to ALK/ROS1 and EGFR inhibitors.
Finally, ctDNA-defined ERRFI1 loss-of-function variants were validated in neuroblastoma cellular models, with the mutant proteins exhibiting loss of wild-type ERRFI1's tumor suppressive functions. Taken together, ctDNA is prevalent in children with high-risk neuroblastoma and should be followed throughout neuroblastoma treatment.