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Piotrowska, Zofia

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Piotrowska

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Zofia

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Piotrowska, Zofia

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20162

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Author's Publications: search.filters.isAuthorOfPublication.40590691-7b99-4596-ada6-f4cff7ae9a3b

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    Tumor cells can follow distinct evolutionary paths to become resistant to epidermal growth factor receptor inhibition
    (2016) Hata, Aaron; Niederst, Matthew J; Archibald, Hannah L; Gomez-Caraballo, Maria; Siddiqui, Faria M; Mulvey, Hillary E; Maruvka, Yosef; Ji, Fei; Bhang, Hyo-eun C; Radhakrishna, Viveksagar Krishnamurthy; Siravegna, Giulia; Hu, Haichuan; Raoof, Sana; Lockerman, Elizabeth; Kalsy, Anuj; Lee, Dana; Keating, Celina L; Ruddy, David A; Damon, Leah J; Crystal, Adam S; Costa, Carlotta; Piotrowska, Zofia; Bardelli, Alberto; Iafrate, Anthony; Sadreyev, Ruslan; Stegmeier, Frank; Getz, Gad; Sequist, Lecia; Faber, Anthony C; Engelman, Jeffrey A
    Although mechanisms of acquired resistance of EGFR mutant non-small cell lung cancers to EGFR inhibitors have been identified, little is known about how resistant clones evolve during drug therapy. Here, we observe that acquired resistance caused by the T790M gatekeeper mutation can occur either by selection of pre-existing T790M clones or via genetic evolution of initially T790M-negative drug tolerant cells. The path to resistance impacts the biology of the resistant clone, as those that evolved from drug tolerant cells had a diminished apoptotic response to third generation EGFR inhibitors that target T790M EGFR; treatment with navitoclax, an inhibitor of BCL-XL and BCL-2 restored sensitivity. We corroborated these findings using cultures derived directly from EGFR inhibitor-resistant patient tumors. These findings provide evidence that clinically relevant drug resistant cancer cells can both pre-exist and evolve from drug tolerant cells, and point to therapeutic opportunities to prevent or overcome resistance in the clinic.
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    Circulating tumour DNA profiling reveals heterogeneity of EGFR inhibitor resistance mechanisms in lung cancer patients
    (Nature Publishing Group, 2016) Chabon, Jacob J.; Simmons, Andrew D.; Lovejoy, Alexander F.; Esfahani, Mohammad S.; Newman, Aaron M.; Haringsma, Henry J.; Kurtz, David M.; Stehr, Henning; Scherer, Florian; Karlovich, Chris A.; Harding, Thomas C.; Durkin, Kathleen A.; Otterson, Gregory A.; Purcell, W. Thomas; Camidge, D. Ross; Goldman, Jonathan W.; Sequist, Lecia; Piotrowska, Zofia; Wakelee, Heather A.; Neal, Joel W.; Alizadeh, Ash A.; Diehn, Maximilian
    Circulating tumour DNA (ctDNA) analysis facilitates studies of tumour heterogeneity. Here we employ CAPP-Seq ctDNA analysis to study resistance mechanisms in 43 non-small cell lung cancer (NSCLC) patients treated with the third-generation epidermal growth factor receptor (EGFR) inhibitor rociletinib. We observe multiple resistance mechanisms in 46% of patients after treatment with first-line inhibitors, indicating frequent intra-patient heterogeneity. Rociletinib resistance recurrently involves MET, EGFR, PIK3CA, ERRB2, KRAS and RB1. We describe a novel EGFR L798I mutation and find that EGFR C797S, which arises in ∼33% of patients after osimertinib treatment, occurs in <3% after rociletinib. Increased MET copy number is the most frequent rociletinib resistance mechanism in this cohort and patients with multiple pre-existing mechanisms (T790M and MET) experience inferior responses. Similarly, rociletinib-resistant xenografts develop MET amplification that can be overcome with the MET inhibitor crizotinib. These results underscore the importance of tumour heterogeneity in NSCLC and the utility of ctDNA-based resistance mechanism assessment.