The presence of concomitant mutations affects the activity of egfr tyrosine kinase inhibitors in egfr-mutant non-small cell lung cancer (Nsclc) patients

Anna Maria Rachiglio, Francesca Fenizia, Maria Carmela Piccirillo, Domenico Galetta, Lucio Crinò, Bruno Vincenzi, Emiddio Barletta, Carmine Pinto, Francesco Ferraù, Matilde Lambiase, Agnese Montanino, Cristin Roma, Vienna Ludovini, Elisabetta Sara Montagna, Antonella De Luca, Gaetano Rocco, Gerardo Botti, Francesco Perrone, Alessandro Morabito, Nicola Normanno

Research output: Contribution to journalArticle


Recent findings suggest that a fraction of EGFR-mutant non-small-cell lung cancers (NSCLC) carry additional driver mutations that could potentially affect the activity of EGFR tyrosine kinase inhibitors (TKIs). We investigated the role of concomitant KRAS, NRAS, BRAF, PIK3CA, MET and ERBB2 mutations (other mutations) on the outcome of 133 EGFR mutant patients, who received first-line therapy with EGFR TKIs between June 2008 and December 2014. Analysis of genomic DNA by Next Generation Sequencing (NGS) revealed the presence of hotspot mutations in genes other than the EGFR, including KRAS, NRAS, BRAF, ERBB2, PIK3CA, or MET, in 29/133 cases (21.8%). A p.T790M mutation was found in 9/133 tumour samples (6.8%). The progression free survival (PFS) of patients without other mutations was 11.3 months vs. 7 months in patients with other mutations (log-rank test univariate: p = 0.047). In a multivariate Cox regression model including the presence of other mutations, age, performance status, smoking status, and the presence of p.T790M mutations, the presence of other mutations was the only factor significantly associated with PFS (Hazard Ratio 1.63, 95% CI 1.04–2.58; p = 0.035). In contrast, no correlation was found between TP53 mutations and patients’ outcome. These data suggest that a subgroup of EGFR mutant tumours have concomitant driver mutations that might affect the activity of first-line EGFR TKIs.

Original languageEnglish
Article number341
Issue number3
Publication statusPublished - Mar 10 2019



  • EGFR mutations
  • Lung cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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