Reference Detail

Ref Type

Journal Article

PMID

(34250419)

Authors

Varghese AM, Patel J, Janjigian YY, Meng F, Selcuklu SD, Iyer G, Houck-Loomis B, Harding JJ, O'Reilly EM, Abou-Alfa GK, Lowery MA, Berger MF

Title

Noninvasive Detection of Polyclonal Acquired Resistance to FGFR Inhibition in Patients With Cholangiocarcinoma Harboring FGFR2 Alterations.

Journal	Vol	Issue	Date	Pages	Journal Short Title
JCO precision oncology	5		2021		JCO Precis Oncol

URL

Abstract Text

Fibroblast growth factor receptor (FGFR) 2 alterations, present in 5%-15% of intrahepatic cholangiocarcinomas (IHC), are targets of FGFR-directed therapies. Acquired resistance is common among patients who respond. Biopsies at the time of acquired resistance to targeted agents may not always be feasible and may not capture the genetic heterogeneity that could exist within a patient. We studied circulating tumor DNA (ctDNA) as a less invasive means of potentially identifying genomic mechanisms of resistance to FGFR-targeted therapies.Serial blood samples were collected from eight patients with FGFR-altered cholangiocarcinoma for ctDNA isolation and next-generation sequencing (NGS) throughout treatment and at resistance to anti-FGFR-targeted therapy. ctDNA was sequenced using a custom ultra-deep coverage NGS panel, incorporating dual index primers and unique molecular barcodes to enable high-sensitivity mutation detection.Thirty-one acquired mutations in FGFR2, 30/31 located in the kinase domain, were identified at resistance in six of eight patients with detectable ctDNA. Up to 13 independent FGFR2 mutations were detected per patient, indicative of striking genomic concordance among resistant subclones.ctDNA could be an effective means to longitudinally monitor for acquired resistance in FGFR2-altered IHC. The numerous acquired genetic alterations in FGFR2 suggest frequent polyclonal mechanisms of resistance that cannot be detected from single-site tissue biopsies.

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Molecular Profile	Treatment Approach

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description	Associated with drug Resistance
FGFR2	D650Y	missense	unknown	FGFR2 D650Y lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). D650Y has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Jun 2023).
FGFR2	K659Q	missense	unknown	FGFR2 K659Q lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). K659Q has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Nov 2023).	Y
FGFR2	L550F	missense	unknown	FGFR2 L550F lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). L550F has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Nov 2023).	Y
FGFR2	M538L	missense	unknown	FGFR2 M538L lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). M538L has been identified as a secondary resistance mutation in the context of an FGFR2 fusion (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Jun 2023).
FGFR2	N652S	missense	unknown	FGFR2 N652S lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). N652S has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Nov 2023).	Y
FGFR2	Q746L	missense	unknown	FGFR2 Q746L lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). Q746L has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Nov 2023).	Y
FGFR2	Y779C	missense	unknown	FGFR2 Y779C lies within the protein kinase domain of the Fgfr2 protein (UniProt.org). Y779C has been demonstrated to confer resistance to Fgfr inhibitors as a secondary resistance mutation (PMID: 34250419), but has not been biochemically characterized and therefore, its effect on Fgfr2 protein function is unknown (PubMed, Nov 2023).	Y

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
FGFR2 amp	cholangiocarcinoma	sensitive	Infigratinib	Case Reports/Case Series	Actionable	In a clinical case study, treatment with Truseltiq (infigratinib) resulted in stable disease for 3.9 months in a patient with cholangiocarcinoma with amplification of FGFR2 (PMID: 34250419).	34250419
FGFR2 M537I FGFR2 V564L FGFR2 amp	cholangiocarcinoma	predicted - resistant	Infigratinib	Case Reports/Case Series	Actionable	In a clinical case study, a patient with cholangiocarcinoma with amplification of FGFR2 experienced disease progression after 3.9 months of treatment with Truseltiq (infigratinib) and was found to have acquired additional FGFR2 mutations, M537I and V564L (PMID: 34250419).	34250419