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Despite biomarker stratification, the anti-EGFR antibody cetuximab is only effective against a subgroup of colorectal cancers (CRCs). This genomic and transcriptomic analysis of the cetuximab resistance landscape in 35 RAS wild-type CRCs identified associations of NF1 and non-canonical RAS/RAF aberrations with primary resistance and validated transcriptomic CRC subtypes as non-genetic predictors of benefit. Sixty-four percent of biopsies with acquired resistance harbored no genetic resistance drivers. Most of these had switched from a cetuximab-sensitive transcriptomic subtype at baseline to a fibroblast- and growth factor-rich subtype at progression. Fibroblast-supernatant conferred cetuximab resistance in vitro, confirming a major role for non-genetic resistance through stromal remodeling. Cetuximab treatment increased cytotoxic immune infiltrates and PD-L1 and LAG3 immune checkpoint expression, potentially providing opportunities to treat cetuximab-resistant CRCs with immunotherapy.
570, EGFR, Biopsy, DNA Mutational Analysis, Drug Resistance, 610, Cetuximab, Antineoplastic Agents, colorectal cancer, Kaplan-Meier Estimate, Article, Cancer evolution, Molecular subtype, Antineoplastic Agents, Immunological, cetuximab, Cancer genomics, Biomarkers, Tumor, Humans, Molecular Targeted Therapy, predictive biomarker, Cancer-associated fibroblasts, Neoplastic, cancer genomics, Tumor, cancer evolution, Drug resistance mechanisms, Gene Expression Profiling, Immunity, Computational Biology, molecular subtype, Prognosis, Colorectal cancer, ErbB Receptors, Gene Expression Regulation, Neoplastic, Predictive biomarker, Immunological, Treatment Outcome, Gene Expression Regulation, drug resistance mechanisms, Drug Resistance, Neoplasm, Mutation, Neoplasm, immunotherapy, Immunotherapy, Colorectal Neoplasms, Transcriptome, cancer-associated fibroblasts, Biomarkers
570, EGFR, Biopsy, DNA Mutational Analysis, Drug Resistance, 610, Cetuximab, Antineoplastic Agents, colorectal cancer, Kaplan-Meier Estimate, Article, Cancer evolution, Molecular subtype, Antineoplastic Agents, Immunological, cetuximab, Cancer genomics, Biomarkers, Tumor, Humans, Molecular Targeted Therapy, predictive biomarker, Cancer-associated fibroblasts, Neoplastic, cancer genomics, Tumor, cancer evolution, Drug resistance mechanisms, Gene Expression Profiling, Immunity, Computational Biology, molecular subtype, Prognosis, Colorectal cancer, ErbB Receptors, Gene Expression Regulation, Neoplastic, Predictive biomarker, Immunological, Treatment Outcome, Gene Expression Regulation, drug resistance mechanisms, Drug Resistance, Neoplasm, Mutation, Neoplasm, immunotherapy, Immunotherapy, Colorectal Neoplasms, Transcriptome, cancer-associated fibroblasts, Biomarkers
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