Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) are highly effective therapies for sub-populations of non-small cell lung cancers. Specific mutations have been identified in the EGFR gene such as L858R which overstimulate cell pathways that lead to tumor growth. All tumors eventually develop resistance to this treatment, rendering them useless, and tumor growth progresses. Escape mutations in the EGFR gene were first seen in patients undergoing treatment with first-generation TKI erlotinib and gefitinib. T790M is a widely seen gate-keeping mutation which overcomes inhibition from erlotinib and gefitinib. Third-generation irreversible TKI, osimertinib, can inhibit tumor cells with this gate-keeping mutation thus overcoming a major hurdle in containment of tumor growth. Unfortunately, patients eventually develop resistance to osimertinib, exhausting options for managing non-small cell lung cancer. Here we analyzed H1975 cells which harbor L858R + T790M mutations. We aimed to track genomic, transcriptomic, and proteomic changes to uncover mechanisms cells use to develop resistance to osimertinib. We established cell colonies which were able to survive high dose treatment up to 2 µM osimertinib. We also saved cells with IC50 of 30 nM to represent drug-tolerant cells. We conducted single-cell sequencing of mRNA transcription and performed hierarchal gene analysis which identified CD74 as a novel factor which was upregulated in drug-tolerant cells. Further we showed CD74 gene was accessible as open chromatin for easy upregulation. Western blot analysis showed increased expression of CD74 after 24 hours of osimertinib treatment. Using siRNA in H1975 cells, we conducted knockdown experiments of CD74 during osimertinib treatment and showed reduced viability. Next, H1975 cells lines were engineered with deletions in CD74 to knockout its expression. These cells also showed reduced viability in the presence of osimertinib. Quantification of apoptosis using caspase-glo assays showed greater activation of apoptosis in cell populations without CD74 compared to normal H1975 cells. H1975-CD74 knockout cells also took longer to become resistant to osimertinib when compared with control. These results show the role of CD74 in helping tumor cells survive EGFR TKI treatment. / 2023-12-05T00:00:00Z

The epidermal growth factor receptor (EGFR)-K745_E746insIPVAIK and others with rare PVAI amino-acid insertions are exon 19 insertion mutations (<1% of all EGFR mutations), which, at the structural modeling level, resemble EGFR tyrosine kinase inhibitor (TKI)-sensitizing mutants. An important unmet clinical need is the characterization of therapeutic windows of rare exon 19 PVAI amino-acid insertions to available EGFR TKIs. A limited number of preclinical and clinical reports have studied the response of these mutants to all classes of approved EGFR TKIs. We used models of EGFR-K745_E746insIPVAIK and more typical EGFR mutations (exon 19 deletion, L858R, L861Q, G719S, A763_Y764insFQEA, other exon 20 insertion mutations) to probe representative 1st (erlotinib), 2nd (afatinib), 3rd generation (osimertinib), and EGFR exon 20 active (mobocertinib) TKIs. We used human lung-cancer derived cell lines and transduced Ba/F3 cells to measure the treatment efficacy. We also compiled outcomes of EGFR exon 19 insertion mutated lung cancers−from our institution plus the literature−treated with EGFR TKIs. Cells driven by EGFR-K745_E746insIPVAIK had sensitivity to all classes of EGFR TKIs when compared to cells driven by EGFR-wild type in proliferation assays and at the protein level. However, the therapeutic window (calculated in preclinical models as the logarithm of the 50% inhibitory concentration of EGFR mutation compared to wild-type EGFR) of EGFR-K745_E746insIPVAIK driven cells was most akin to those of cells driven by EGFR-L861Q, EGFR-G719S and EGFR- A763_Y764insFQEA than the more sensitive patterns seen with cells driven by an EGFR exon 19 deletion or EGFR-L858R. The majority of patients with lung cancers harboring EGFR- K745_E746insIPVAIK and other mutations with rare PVAI amino-acid insertions responded to clinically available EGFR TKIs (including icotinib, gefitinib, erlotinib, afatinib and osimertinib), with heterogeneous periods of progression-free survival. This is the largest preclinical/clinical report to highlight that EGFR- K745_E746insIPVAIK and other mutations with rare exon 19 PVAI amino-acid insertions are sensitive to clinically available TKIs; in a pattern that mostly resembles the outcomes of models with EGFR-L861Q, EGFR-G719S and EGFR-A763_Y764insFQEA mutations. These findings are consistent with the proposed mechanism of activation of mutant EGFR by alteration of the proposed hydrophobic core. These data may help with the off-label selection of EGFR TKIs and clinical expectations of outcomes when targeted therapy is deployed for these rare EGFR mutated lung cancers. / 2026-03-08T00:00:00Z