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A correction has been published: N Engl J Med 2006;354(8):884.

Original Article
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Volume 353:2012-2024 November 10, 2005 Number 19
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Molecular Determinants of the Response of Glioblastomas to EGFR Kinase Inhibitors
Ingo K. Mellinghoff, M.D., Maria Y. Wang, M.D., Ph.D., Igor Vivanco, Ph.D., Daphne A. Haas-Kogan, M.D., Shaojun Zhu, M.S., Ederlyn Q. Dia, B.S., Kan V. Lu, Ph.D., Koji Yoshimoto, M.D., Ph.D., Julie H.Y. Huang, B.S., Dennis J. Chute, M.D., Bridget L. Riggs, B.S., Steve Horvath, Ph.D., Linda M. Liau, M.D., Ph.D., Webster K. Cavenee, Ph.D., P. Nagesh Rao, Ph.D., Rameen Beroukhim, M.D., Timothy C. Peck, B.S., Jeffrey C. Lee, B.S., William R. Sellers, M.D., David Stokoe, Ph.D., Michael Prados, M.D., Timothy F. Cloughesy, M.D., Charles L. Sawyers, M.D., and Paul S. Mischel, M.D.

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ABSTRACT

Background The epidermal growth factor receptor (EGFR) is frequently amplified, overexpressed, or mutated in glioblastomas, but only 10 to 20 percent of patients have a response to EGFR kinase inhibitors. The mechanism of responsiveness of glioblastomas to these inhibitors is unknown.

Methods We sequenced kinase domains in the EGFR and human EGFR type 2 (Her2/neu) genes and analyzed the expression of EGFR, EGFR deletion mutant variant III (EGFRvIII), and the tumor-suppressor protein PTEN in recurrent malignant gliomas from patients who had received EGFR kinase inhibitors. We determined the molecular correlates of clinical response, validated them in an independent data set, and identified effects of the molecular abnormalities in vitro.

Results Of 49 patients with recurrent malignant glioma who were treated with EGFR kinase inhibitors, 9 had tumor shrinkage of at least 25 percent. Pretreatment tissue was available for molecular analysis from 26 patients, 7 of whom had had a response and 19 of whom had rapid progression during therapy. No mutations in EGFR or Her2/neu kinase domains were detected in the tumors. Coexpression of EGFRvIII and PTEN was significantly associated with a clinical response (P<0.001; odds ratio, 51; 95 percent confidence interval, 4 to 669). These findings were validated in 33 patients who received similar treatment for glioblastoma at a different institution (P=0.001; odds ratio, 40; 95 percent confidence interval, 3 to 468). In vitro, coexpression of EGFRvIII and PTEN sensitized glioblastoma cells to erlotinib.

Conclusions Coexpression of EGFRvIII and PTEN by glioblastoma cells is associated with responsiveness to EGFR kinase inhibitors.


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From the Departments of Molecular and Medical Pharmacology and Medicine (I.K.M., C.L.S.), Pathology and Laboratory Medicine (M.Y.W., S.Z., E.Q.D., K.V.L., K.Y., D.J.C., B.L.R., P.N.R., P.S.M.), Human Genetics (J.H.Y.H., S.H.), Biostatistics (S.H.), Neurosurgery (L.M.L.), and Neurology (T.F.C.); the Henry E. Singleton Brain Tumor Program (I.K.M., L.M.L., T.F.C., P.S.M.); the Molecular Biology Institute (I.V., C.L.S.); and the Howard Hughes Medical Institute (C.L.S.) — all at the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles; the Department of Neurological Surgery, University of California, San Francisco, San Francisco (D.A.H.-K., D.S., M.P.); the Ludwig Institute for Cancer Research at the University of California, San Diego, San Diego (W.K.C.); and the Department of Medical Oncology, Dana–Farber Cancer Institute, the Department of Medicine, Harvard Medical School, and the Broad Institute of Harvard and the Massachusetts Institute of Technology — all in Boston (R.B., T.C.P., J.C.L., W.R.S.).

Drs. Mellinghoff, Wang, and Vivanco contributed equally to the article.

Address reprint requests to Dr. Mischel at the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Center for the Health Sciences, Room 13-321, Los Angeles, CA 90095-1732, or at pmischel{at}mednet.ucla.edu.

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Related Letters:

Response of Glioblastomas to EGFR Kinase Inhibitors
Lassman A. B., Abrey L. E., Gilbert M. R., Mellinghoff I. K., Cloughesy T., Mischel P. S.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:525-526, Feb 2, 2006. Correspondence

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