• What is EGFR?
  • EGFR in Lung Cancer
  • EGFR c.2290_2291ins (A763_Y764insFQEA)
  • Clinical Trials


Epidermal growth factor receptor (EGFR) belongs to a family of receptor tyrosine kinases (RTKs) that include EGFR/ERBB1, HER2/ERBB2/NEU, HER3/ERBB3, and HER4/ERBB4. The binding of ligands, such as epidermal growth factor (EGF), induces a conformational change that facilitates receptor homo- or heterodimer formation, thereby resulting in activation of EGFR tyrosine kinase activity. Activated EGFR then phosphorylates its substrates, resulting in activation of multiple downstream pathways within the cell, including the PI3K-AKT-mTOR pathway, which is involved in cell survival, and the RAS-RAF-MEK-ERK pathway, which is involved in cell proliferation (Figure 1).


Figure 1.
Schematic of EGFR signaling pathway. Growth factor binding to EGFR results in activation of the MAPK signaling pathway (RAS-RAF-MEK-ERK) and the PI3K pathway (PI3K-AKT-mTOR). The letter "K" within the schema denotes the tyrosine kinase domain.

Related Pathways

Contributors: Christine M. Lovly, M.D., Ph.D., Leora Horn, M.D., M.Sc., William Pao, M.D., Ph.D. (through April 2014)

Suggested Citation: Lovly, C., L. Horn, W. Pao. 2015. EGFR. My Cancer Genome https://www.padiracinnovation.org/content/disease/lung-cancer/egfr/?tab=0 (Updated December 7).

Last Updated: December 7, 2015

EGFR in Non-Small Cell Lung Cancer (NSCLC)

Approximately 10% of patients with NSCLC in the US and 35% in East Asia have tumor associated EGFR mutations (Lynch et al. 2004; Paez et al. 2004; Pao et al. 2004). These mutations occur within EGFR exons 18–21, which encodes a portion of the EGFR kinase domain (Figure 1). EGFR mutations are usually heterozygous, with the mutant allele also showing gene amplification (Soh et al. 2009). Approximately 90% of these mutations are exon 19 deletions or exon 21 L858R point mutations (Ladanyi and Pao 2008​). These mutations increase the kinase activity of EGFR, leading to hyperactivation of downstream pro-survival signaling pathways (Sordella et al. 2004).

Regardless of ethnicity, EGFR mutations are more often found in tumors from female never smokers (defined as less than 100 cigarettes in a patient's lifetime) with adenocarcinoma histology (Lynch et al. 2004; Paez et al. 2004; Pao et al. 2004). However, EGFR mutations can also be found in other subsets of NSCLC, including in former and current smokers as well as in other histologies.

In the vast majority of cases, EGFR mutations are non-overlapping with other oncogenic mutations found in NSCLC (e.g., KRAS mutations, ALK rearrangements, etc.).


Figure 1.
Schematic of EGFR mutations. Exons 18–21 of the EGFR kinase domain are depicted. Mutations above the schematic are associated with sensitivity to EGFR TKIs. Mutations listed below the schematic are associated with EGFR TKI resistance. 
NOTE: a While most exon 20 insertions are associated with decreased EGFR TKI sensitivity, the EGFR A763_Y764insFQEA mutation is an exception and has been associated in retrospective studies with increased EGFR TKI sensitivity (Yasuda et al. 2013).



Contributors: Christine M. Lovly, M.D., Ph.D., Leora Horn, M.D., M.Sc., William Pao, M.D., Ph.D. (through April 2014)

Suggested Citation: Lovly, C., L. Horn, W. Pao. 2015. EGFR in Non-Small Cell Lung Cancer (NSCLC). My Cancer Genome https://www.padiracinnovation.org/content/disease/lung-cancer/egfr/ (Updated June 18).

Last Updated: June 18, 2015

EGFR c.2290_2291ins (A763_Y764insFQEA) Mutation in Non-Small Cell Lung Cancer

Location of mutation Kinase domain (exon 20)
Frequency of EGFR mutations in NSCLC ~10% in the USA
~35% in Asia
(Lynch et al. 2004; Paez et al. 2004; Pao et al. 2004)
Frequency of A763_Y764insFQEA mutations in EGFR-mutated NSCLC <1% (Arcila et al. 2013; Mitsudomi and Yatabe 2010; Oxnard et al. 2013)
Implications for Targeted Therapeutics
Response to EGFR TKIs Confers increased sensitivitya
Response to anti-EGFR antibodies Currently no role for EGFR mutation in predicting response in NSCLC

The A763_Y764insFQEA mutation is an in-frame insertion that occurs in EGFR in the kinase domain of exon 20.

a EGFR A763_Y764insFQEA more closely resembles EGFR L858R or L861Q than it does other exon 20 insertion mutations at the structural and enzyme kinetic level, because the inserted FQEA sequence shifts the register of EGFR’s C-helix toward its N-terminus (Yasuda et al. 2013). EGFR A763_Y764insFQEA is associated in preclinical models with increased sensitivity to clinically achievable doses of the reversible EGFR TKIs, erlotinib (Tarceva) and gefitinib (Iressa), and of the irreversible EGFR TKI afatinib (Gilotrif; Yasuda et al. 2013).

In a retrospective analysis of patients with EGFR exon 20 insertion mutated NSCLC, all 3 patients with advanced lung cancer harboring the EGFR exon 20 insertion mutation A763_Y764insFQEA treated with the EGFR TKI erlotinib achieved stable disease or partial responses (Yasuda et al. 2013). Almost all other NSCLCs harboring other EGFR exon 20 insertions displayed progressive disease in the course of treatment with gefitinib or erlotinib (Yasuda et al. 2013).​​

For information about a specific exon 20 insertion or A763_Y764insFQEA, please fill out the DIRECT request form. DIRECT catalogues drug response data from patients with non-small cell lung cancer whose tumors harbor mutations in EGFR.


Contributors: Daniel B. Costa, M.D., Ph.D., M.MSc.

Suggested Citation: Costa, D. 2014. EGFR c.2290_2291ins (A763_Y764insFQEA) Mutation in Non-Small Cell Lung Cancer. My Cancer Genome https://www.padiracinnovation.org/content/disease/lung-cancer/egfr/312/ (Updated October 20).

Last Updated: October 20, 2014

My Cancer Genome has released its new and improved cancer clinical trials search tool on our beta website. Please visit beta.padiracinnovation.org to check it out!

Disclaimer: The information presented at padiracinnovation.org is compiled from sources believed to be reliable. Extensive efforts have been made to make this information as accurate and as up-to-date as possible. However, the accuracy and completeness of this information cannot be guaranteed. Despite our best efforts, this information may contain typographical errors and omissions. The contents are to be used only as a guide, and health care providers should employ sound clinical judgment in interpreting this information for individual patient care.