- Blakely, Collin M;
- Watkins, Thomas BK;
- Wu, Wei;
- Gini, Beatrice;
- Chabon, Jacob J;
- McCoach, Caroline E;
- McGranahan, Nicholas;
- Wilson, Gareth A;
- Birkbak, Nicolai J;
- Olivas, Victor R;
- Rotow, Julia;
- Maynard, Ashley;
- Wang, Victoria;
- Gubens, Matthew A;
- Banks, Kimberly C;
- Lanman, Richard B;
- Caulin, Aleah F;
- St John, John;
- Cordero, Anibal R;
- Giannikopoulos, Petros;
- Simmons, Andrew D;
- Mack, Philip C;
- Gandara, David R;
- Husain, Hatim;
- Doebele, Robert C;
- Riess, Jonathan W;
- Diehn, Maximilian;
- Swanton, Charles;
- Bivona, Trever G
A widespread approach to modern cancer therapy is to identify a single oncogenic driver gene and target its mutant-protein product (for example, EGFR-inhibitor treatment in EGFR-mutant lung cancers). However, genetically driven resistance to targeted therapy limits patient survival. Through genomic analysis of 1,122 EGFR-mutant lung cancer cell-free DNA samples and whole-exome analysis of seven longitudinally collected tumor samples from a patient with EGFR-mutant lung cancer, we identified critical co-occurring oncogenic events present in most advanced-stage EGFR-mutant lung cancers. We defined new pathways limiting EGFR-inhibitor response, including WNT/β-catenin alterations and cell-cycle-gene (CDK4 and CDK6) mutations. Tumor genomic complexity increases with EGFR-inhibitor treatment, and co-occurring alterations in CTNNB1 and PIK3CA exhibit nonredundant functions that cooperatively promote tumor metastasis or limit EGFR-inhibitor response. This study calls for revisiting the prevailing single-gene driver-oncogene view and links clinical outcomes to co-occurring genetic alterations in patients with advanced-stage EGFR-mutant lung cancer.