Nevertheless such mutations were not identified in our study. Re-biopsy following relapse was not conducted in this study limiting our understanding of the possible acquisition of T790M. Other EGFR mutations reportedly correlated to resistance, such as D761Y, L747S, and A854A, were also not identified in our series. Preclinical data suggest that amplification of the MET proto-oncogene may play a role in acquired resistance to EGFR TKIs through the PI3K pathway. MET amplification has been detected in lung cancer cell lines that have acquired resistance to gefitinib. Current evidence this website implies that MET amplification occurs independently of T790M and

it has been proposed that concurrent inhibition of both may further improve clinical outcomes. Recently, a large retrospective study of surgically resected NSCLC showed that increased MET GCN is an independent negative prognostic factor [28]. In our small series, high MET gene gain was found in only one patient, and overall gene gain in 16%

of cases. None of the tested cases showed amplification. Previous reports, using different interpretation methodologies of MET gene status, showed a gene gain between 11-50%, and amplification in 3-11% of patient’s tumors [28, 34]. Loss of heterozygosity (LOH) has been frequently detected at chromosome 7q31 region in several solid tumors including head and neck squamous cell carcinomas, Selleckchem Buparlisib prostate, breast and ovarian cancers, suggesting the existence of tumor suppressor genes. Deletions at 7q31 region appear to be very common phenomenon in cancer, and are correlated with a more aggressive phenotype. Monosomy 7 and loss of chromosome 7q are also observed in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). In some instances, these abnormalities

are associated find more with patient outcome. D7S486 locus deletion has been frequently detected in head and neck squamous cell carcinomas and prostate adenocarcinomas and has been associated with higher grade and advanced tumor stage [35]. In our study D7S486 locus deletion was detected in 40% of cases but no association with clinical outcome was demonstrated. Nevertheless, the role of LOH at 7q31 region has not been investigated in NSCLC and neither its possible associations with MET gene, which is mapped to 7q31 seems to be an interesting area of investigation in NSCLC. KRAS is a signaling molecule downstream of EGFR. KRAS and EGFR play pivotal roles in the development and growth of NSCLC, especially in patients with adenocarcinoma histology. Patients with KRAS mutations respond poorly to EGFR inhibitors, with increasing data implicating KRAS mutations as a mechanism of primary resistance to EGFR TKIs [17]. Activating mutations in codons 12 and 13 of the KRAS gene are present in approximately 15–30% of NSCLC cases [36].