Abstract 5774: Are 19del and L858R really not the same disease entities
Authors: Heo Yunseok , Kim Joo Ri , Sung Yeoun Eun , Kim Seoree , Jung Chan Kwon , Kim Jeong-Oh , Shin Jeong-yeon , Lee Guk Jin , Chun Sang hoon , Bu Seong Hyeon , Lee Young Ho , Kang Jin Hyoung 
Published: March 2024

Abstract
IntroductionThe similarities and differences between the two subtypes of common epidermal growth factor receptor (EGFR) mutations have been recognized by clinicians, but actual treatment strategies remain unchanged. The L858R mutation can be explained by the pharmacological conformational plasticity of the receptor protein and other co-occurring mutations, which may be subtypes of EGFR mutations or non-EGFR mutations, and differences in downstream signaling pathways. As long as we know that molecular differences lead to biological differences, it is a challenge for all of us that our treatment strategies must changeWe investigated the RWD, conformational structure and RNA expression profile about two types of common mutations in the mEGFR+ NSCLC patients.MethodWe collected the medical information for stage I-IIIA mEGFR+ NSCLC patients and explored the conformational structure by crystalized radiologic technique. And we performed RNA expression assay using multiplex IF and High-through-output Profiling. ResultOverall, the static structures of wild type (WT), L858R, and 19del (ΔL747-E749) EGFR did not show any significant differences. However, the difference in the static structure between WT-19del and L858R-19del was subtly greater than that of WT-L858R. In addition, further analyses demonstrated no significant structural differences in the phosphorylation sites. However, it should be noted that proteins do not exist as static structures in vivo, and they have a dynamic, flexible structure that changes over time, i.e., plasticity of proteins. Therefore, we investigated the X-ray B-factor value, which is an indicator of flexibility, dynamics, and plasticity of proteins. As expected, the loop or disordered regions mainly shows higher B-factor values, which indicates an active structure, highly changeable and dynamic. Together, the three types of the EGFR protein manifest wholly similar B-factor values, while several local regions present appreciably distinct B-factors. Physical properties such as the dynamic structure may affect intermolecular recognition of EGFR proteins and their function Recent biochemical and biophysical evidence suggests that oncogenic mutations have an impact on the conformational dynamics of enzymesConclusionIn conclusion, our results suggest that Patients with 19del and L858R mutations demonstrated a different clinical course.
It is necessary to consider the dynamic structural characteristics and functional differences of EGFR membrane proteins.
Citation Format: Yunseok Heo, Joo Ri Kim, Yeoun Eun Sung, Seoree Kim, Chan Kwon Jung, Jeong-Oh Kim, Jeong-yeon Shin, Guk Jin Lee, Sang hoon Chun, Seong Hyeon Bu, Young Ho Lee, Jin Hyoung Kang. Are 19del and L858R really not the same disease entities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5774.