¿Importa la secuencia de tratamiento en egfr +?: Factores que deberían ser considerados

Erlotinib

Gefitinib

Afatinib

Osimertinib

T790M+

EGFR

activating

mutation

T790M-

T790M (-) plus

bypass

resistance

T790M (-) plus

bypass mechanism

T790M+ plus

C797S (or other

second site EGFR

mutation)

= Resistance mechanism due to activation of bypass or downstream signaling pathway

= EGFR C797S (or other EGFR second site mutation)

= EGFR T790M

Clonal Evolution of EGFR Mutant Lung Cancer on Therapy:

How does front line osimertinib affect this model?

Adapted from Jänne et al ASCO 2106

To be determined if resistant

clones exist in pre-treated cells