Fig. 1

Identification of EGFR L792F and L792H mutations by cfDNA sequencing in osimertinib-resistant NSCLC. Somatic cfDNA profiling of a patient progressing on osimertinib revealed the known resistance mutation C797S, as well as novel EGFR mutations L792F, L792H, and F795C. a Patient treatment history. b Abdominal CT 2 months after initiation of osimertinib, showing stable hepatic metastases. c Abdominal CT 7 months after initiation on osimertinib, showing multifocal progression throughout the liver. d Schema of somatic EGFR mutations identified by cfDNA NGS and corresponding predicted amino acid alterations. e Presumptive evolutionary history inferred by dollo parsimony analysis of phased mutations. G germline, Af afatinib, Osi osimertinib. f The structural location of L792H mutation (magenta) in EGFR relative to T790M (red) and bound TKI (yellow). g The structural location of L792F mutation (purple) in EGFR relative to T790M (red) and bound TKI (yellow)