Whole-exome sequencing identifies key mutated genes in T790M wildtype/cMET-unamplified lung adenocarcinoma with acquired resistance to first-generation EGFR tyrosine kinase inhibitors

  • Chenguang Li
  • Hailin Liu
  • Bin Zhang
  • Liqun Gong
  • Yanjun Su
  • Zhenfa Zhang
  • Changli Wang
Original Article – Cancer Research



Lung cancer is the leading cause of cancer-related death worldwide. Lung adenocarcinoma harboring EGFR-activating mutations will inevitably acquire resistance to first-generation EGFR tyrosine kinase inhibitors (TKIs). EGFR T790M mutation and cMET amplification are common mechanisms. Further study is needed to explore unknown genomic alterations contributing to drug resistance.


Tumor and blood samples from 69 stage IIIB–IV NSCLC patients defined as acquired resistance to first-generation EGFR TKIs (gefitinib, erlotinib or ecotinib) were collected. The cobas® and Droplet digital PCR (ddPCR) were used to detect T790M mutations in tumor samples and plasma ctDNA. cMET amplification was evaluated by fluorescence in situ hybridization (FISH). Exome sequencing was performed in four T790M wildtype/cMET-unamplified samples.


The overall T790M-positive rate was 52.2% considering all testing methods. Out of 21 samples in which tumor re-biopsy was performed, 14 were T790M positive (66.7%). cMET amplification was identified in three out of seven T790M-negative samples. Exome sequencing in four T790M wildtype/cMET-unamplified samples and paired white blood cells identified a cohort of candidate key mutated genes including BRAF, FGFR1, PAK1, PCNT, PEBP4 and SOX3.


EGFR T790M mutation and cMET amplification are main mechanisms leading to EGFR TKI resistance in lung adenocarcinoma. These key mutated genes identified in the present study would need further validation in large number of patients.


Lung adenocarcinoma Exome sequencing Epidermal growth factor receptor T790M cMET 



We thank Yongsheng Sha, Hao He, Lu Ye, Mei Liu, Aiping Xu and Yan Yan for managing clinical samples.

Compliance with ethical standards

Ethical standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

432_2018_2634_MOESM1_ESM.xls (9.3 mb)
Supplementary material 1 (XLS 9502 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Lung CancerTianjin Medical University Cancer Institute and HospitalTianjinChina
  2. 2.National Clinical Research Center for CancerTianjinChina
  3. 3.Key Laboratory of Cancer Prevention and TherapyTianjinChina
  4. 4.Tianjin Lung Cancer CenterTianjinChina

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