Small cell transformation of ROS1 fusion-positive lung cancer resistant to ROS1 inhibition

Jessica J Lin; Adam Langenbucher; Pranav Gupta; Satoshi Yoda; Isobel J Fetter; Marguerite Rooney; Andrew Do; Marina Kem; Kylie Prutisto Chang; Audris Y Oh; Emily Chin; Dejan Juric; Ryan B Corcoran; Ibiayi Dagogo-Jack; Justin F Gainor; James R Stone; Jochen K Lennerz; Michael S Lawrence; Aaron N Hata; Mari Mino-Kenudson; Alice T Shaw

doi:10.1038/s41698-020-0127-9

Small cell transformation of ROS1 fusion-positive lung cancer resistant to ROS1 inhibition

NPJ Precis Oncol. 2020 Aug 3:4:21. doi: 10.1038/s41698-020-0127-9. eCollection 2020.

Authors

Jessica J Lin^{1

2}, Adam Langenbucher^{1

2}, Pranav Gupta^{1

2}, Satoshi Yoda^{1

2}, Isobel J Fetter^{1

2}, Marguerite Rooney^{1

2}, Andrew Do^{1

2}, Marina Kem^{2

3}, Kylie Prutisto Chang^{1

2}, Audris Y Oh^{1

2}, Emily Chin^{1

2}, Dejan Juric^{1

2}, Ryan B Corcoran^{1

2}, Ibiayi Dagogo-Jack^{1

2}, Justin F Gainor^{1

2}, James R Stone^{2

3}, Jochen K Lennerz^{2

3}, Michael S Lawrence^{1

2}, Aaron N Hata^{1

2}, Mari Mino-Kenudson^{2

3}, Alice T Shaw^{1

2}

Affiliations

¹ Department of Medicine, Massachusetts General Hospital, Boston, MA USA.
² Harvard Medical School, Boston, MA USA.
³ Department of Pathology, Massachusetts General Hospital, Boston, MA USA.

Abstract

Histologic transformation from non-small cell to small cell lung cancer has been reported as a resistance mechanism to targeted therapy in EGFR-mutant and ALK fusion-positive lung cancers. Whether small cell transformation occurs in other oncogene-driven lung cancers remains unknown. Here we analyzed the genomic landscape of two pre-mortem and 11 post-mortem metastatic tumors collected from an advanced, ROS1 fusion-positive lung cancer patient, who had received sequential ROS1 inhibitors. Evidence of small cell transformation was observed in all metastatic sites at autopsy, with inactivation of RB1 and TP53, and loss of ROS1 fusion expression. Whole-exome sequencing revealed minimal mutational and copy number heterogeneity, suggestive of "hard" clonal sweep. Patient-derived models generated from autopsy retained features consistent with small cell lung cancer and demonstrated resistance to ROS1 inhibitors. This case supports small cell transformation as a recurring resistance mechanism, and underscores the importance of elucidating its biology to expand therapeutic opportunities.

Keywords: Lung cancer.

Publication types

Case Reports

Abstract

Publication types

Grants and funding