Targeting FGFR in non-small cell lung cancer: implications from the landscape of clinically actionable aberrations of FGFR kinases

Zhen Zhou; Zichuan Liu; Qiuxiang Ou; Xue Wu; Xiaonan Wang; Yang Shao; Hongyan Liu; Yu Yang

doi:10.20892/j.issn.2095-3941.2020.0120

Targeting FGFR in non-small cell lung cancer: implications from the landscape of clinically actionable aberrations of FGFR kinases

Cancer Biol Med. 2021 Mar 12;18(2):490-501. doi: 10.20892/j.issn.2095-3941.2020.0120. Online ahead of print.

Authors

Zhen Zhou^#¹, Zichuan Liu^#², Qiuxiang Ou³, Xue Wu³, Xiaonan Wang⁴, Yang Shao^{3

5}, Hongyan Liu⁶, Yu Yang⁷

Affiliations

¹ Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
² Section No. 2 Internal Medicine, Cancer Center of Guangzhou Medical University, Guangzhou 511436, China.
³ Translational Medicine Research Institute, Geneseeq Technology Inc., Toronto M5G1L7, Canada.
⁴ Nanjing Geneseeq Technology Inc., Nanjing 211500, China.
⁵ School of Public Health, Nanjing Medical University, Nanjing 211166, China.
⁶ Department of Respiratory Medicine, The Second Hospital of Anhui Medical University, Hefei 230031, China.
⁷ Department of Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150086, China.

^# Contributed equally.

PMID: 33710807
PMCID: PMC8185861
DOI: 10.20892/j.issn.2095-3941.2020.0120

Abstract

Objective: Dysfunction in fibroblast growth factor receptor (FGFR) signaling has been reported in diverse cancer types, including non-small cell lung cancer (NSCLC). The frequency of FGFR aberrations in Chinese NSCLC patients is therefore of great clinical significance.

Methods: A total of 10,966 NSCLC patients whose tumor specimen and/or circulating cell-free DNA (cfDNA) underwent hybridization capture-based next-generation sequencing were reviewed. Patients' clinical characteristics and treatment histories were also evaluated.

Results: FGFR aberrations, including mutations, fusions, and gene amplifications, were detected in 1.9% (210/10,966) of the population. FGFR abnormalities were more frequently observed in lung squamous cell carcinomas (6.8%, 65/954) than lung adenocarcinomas (1.3%, 128/9,596). FGFR oncogenic mutations were identified in 19 patients (~0.17%), of which, 68% were male lung squamous cell carcinoma patients. Eleven out of the 19 patients (58%) had concurrent altered PI3K signaling, thus highlighting a potential combination therapeutic strategy of dual-targeting FGFR and PI3K signaling in such patients. Furthermore, FGFR fusions retaining the intact kinase domain were identified in 12 patients (0.11%), including 9 FGFR3-TACC3, 1 FGFR2-INA, 1 novel FGFR4-RAPGEFL1, and 1 novel fusion between the FGFR1 and SLC20A2 5'-untranslated regions, which may have caused FGFR1 overexpressions. Concomitant EGFR mutations or amplifications were observed in 6 patients, and 4 patients received anti-EGFR inhibitors, in whom FGFR fusions may have mediated resistance to anti-EGFR therapies. FGFR amplification was detected in 24 patients, with the majority being FGFR1 amplifications. Importantly, FGFR oncogenic mutations, fusions, and gene amplifications were almost always mutually exclusive events.

Conclusions: We report the prevalence of FGFR anomalies in a large NSCLC population, including mutations, gene amplifications, and novel FGFR fusions.

Keywords: FGFR; fusion; gene amplification; oncogenic mutation; targeted therapy.

Grants and funding

2016YFC1303800/National Key R&D Program of China