Acquired Resistance to Crizotinib in NSCLC with MET Exon 14 Skipping

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Acquired Resistance to Crizotinib in NSCLC with MET Exon 14 Skipping Rebecca S. Heist, MD, MPH, Lecia V. Sequist, MD, MPH, Darrell Borger, PhD, Justin F. Gainor, MD, Ronald S. Arellano, MD, Long P. Le, MD, PhD, Dora Dias-Santagata, PhD, Jeffrey W. Clark, MD, Jeffrey A. Engelman, MD, PhD, Alice T. Shaw, MD, PhD, A. John Iafrate, MD, PhD Journal of Thoracic Oncology Volume 11, Issue 8, Pages 1242-1245 (August 2016) DOI: 10.1016/j.jtho.2016.06.013 Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Computed tomography (CT) scans of a patient with MET proto-oncogene, receptor tyrosine kinase gene (MET) exon 14 skipping showing response and subsequent progression while the patient was receiving crizotinib. (A) Contrast-enhanced coronal CT scan before crizotinib. White arrows indicate hepatic metastases. (B) Contrast-enhanced coronal CT scan at best response to crizotinib. White arrows indicate interval decrease in size of hepatic metastases. (C) Contrast-enhanced coronal CT scan at time of progressive disease. White arrow indicates a new liver metastasis on which a biopsy was performed. Journal of Thoracic Oncology 2016 11, 1242-1245DOI: (10.1016/j.jtho.2016.06.013) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Emergence of a secondary MET proto-oncogene, receptor tyrosine kinase gene (MET) D1228N mutation and proto-oncogene, receptor tyrosine kinase (MET) protein activation upon development of acquired resistance to crizotinib in the setting of MET exon 14 skipping. (A) Sequence alignment shows the original MET exon 14 skipping D1010H mutation and the emergence of the secondary MET D1228N mutation. Immunohistochemical testing identified high levels of total MET protein (B), as well as high levels of active MET protein through immunohistochemical testing for phospho-MET Y1349 (C). Journal of Thoracic Oncology 2016 11, 1242-1245DOI: (10.1016/j.jtho.2016.06.013) Copyright © 2016 International Association for the Study of Lung Cancer Terms and Conditions