e21085 Background: Treatment of nonsmall-cell lung cancer (NSCLC) with tyrosine kinase inhibitors (TKIs) shows initial response, but most tumors develop acquired resistance to TKIs due to secondary resistance mutations (T790M) and amplification of other RTKs. Patients stratified for mono therapy treatment based on genotype alone is not sufficient as other kinases contribute to survival and necessitate inhibition of multiple kinases. Methods: The Collaborative Enzyme Enhanced Reactive-immunoassay (CEER) is a multiplexed protein microarray platform requiring co-localization of two detector enzyme-conjugated-antibodies. CEER is capable of high detection sensitivity from FNA/CTC viable samples (23-35 gage needle). Lysates were prepared from frozen tissues obtained surgically from 71 Caucasian and 29 Asian patients with NSCLC. Expression and activation of EGFR, ErbB2, ErbB3, cMET, IGF1R, cKIT, Shc, PI3K, AKT, ERK, VEGFR2, Src, FAK, Stat5, JAK2, CrKL, and other pathway proteins were profiled. Genotyping on panel of mutations in KRAS, EGFR, and BRAF were performed on all samples. Results: We have observed differential expression patterns between Asian and Caucasian patients. KRAS is mutated in 30% of all the patients. In Asians, EGFR over expression is higher (27%) compared to the Caucasians (3%). Caucasian patients expressed high Her3 (58%), cMET (25%), and co expression of both cMET and HER3 (27%). VEGFR2 is highly expressed in 17% of all patients. Patients over expressing cMET, HER3, and HER2 will benefit from combination of pan-HER and cMET inhibitors. Those over expressing cMET and EGFR will benefit from cMET and EGFR inhibitors. Lastly, patients over expressing VEGFR2 and cMET will benefit from cMET and VEGFR inhibitors. A comprehensive differential biomarker prevalence for each NSCLC sub-populations for all tested RTKs and signaling proteins will be presented. Conclusions: Mono therapy and patient selection based on genotype is not an effective criteria for treatment options. Instead, a comprehensive pathway profile using FNA/CTC should guide selection of appropriate therapy (combined or sequenced), and shifts in pathway profile should be monitored for appropriate response.
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