Epidermal growth factor receptor-activating mutation(E746_T751>VP) in pancreatic ductal adenocarcinoma responds to erlotinib, followed by epidermal growth factor receptor resistance-mediating mutation (A647T): A case report and literature review

Despite recent advances in treatment with multidrug chemotherapy regimens, outcomes of patients with advanced pancreatic ductal adenocarcinoma (PDAC) remain very poor. Treatment with targeted therapies has shown marginal benefits due to intrinsic or acquired resistance. Actionable mutations, while detected infrequently in patients with PDAC, are becoming increasingly used in personalized medicine. Here, we describe an epidermal growth factor receptor (EGFR)-activating mutation (E746_T751>VP) to erlotinib, a first-generation tyrosine kinase inhibitor (TKI), in a patient with metastatic PDAC. After an initial partial response to erlotinib for 12 months, the patient's disease progressed with emergence of the EGFR A647T mutation. Certainly, the patient also progressed after switching therapy to a third-generation EGFR TKI (osimertinib). This case illustrates the posttreatment evolution of EGFR A647T-mediated resistance to the first- and third-generation TKIs. To our knowledge, this is the first case to report the aforementioned activating and resistance-mediated mutations. In summary, genomic analysis performed in this patient with PDAC on the tumor biopsy and peripheral blood provided tools to understand mechanisms of response and resistance to targeted therapy with EFGR TKIs

Phytoplankton composition of Euphrates River in Al-Hindiya barrage and Kifil City region of Iraq.

Seasonal variations in phytoplankton abundance and their composition were studied at five stations in the middle region (between Al-Hindiya barrage to Kifil City) of the Euphrates River in Iraq between March, 2004, and February, 2005. A total 151 taxa of phytoplankton were identified, belonging to Bacillariophyceae (98), Chlorophyceae (33), Cyanophyceae (14), Euglenophyceae (2), Xanthophyceae (2), and Dinophyceae (2). The total abundance of phytoplankton cells varied from 136 to 5312 cells l-1 with maxima in spring and fall. Bacillariophyceae were the most abundant group at all stations. Some species of phytoplankton occurred continuously during the study period (Cyclotella ocellata, C. meneghiana, Cocconeis placentula, Nitzchia spp, Meringosphaera spinosa). The study recorded four species as new records for Iraqi. The phytoplankton was indicative of oligotrophic conditions although it showed some signs of organic pollution near cities.