About EGFR
No gene-level summary was recorded for this case.
No variant summary was recorded for this case.
Five-step scale from benign to pathogenic. This variant is likely pathogenic. Select a step to read what it means.
Likely pathogenic.A likely pathogenic classification under the recorded framework.
Gene-level background from the recorded interpretation.
Words with a dotted underline have a short definition. Hover or tap them.No gene-level summary was recorded for this case.
The recorded framework is Not recorded. The criteria and strengths shown below come from the saved assessment; this page does not recalculate the classification.
The applied criteria and their strengths are shown as assessed under the stated framework.
The exact variant (p.E746_S752delinsV) has been directly observed and characterized in a clinical-functional context. In Han et al. 2005 (PMID:15710947), a patient harboring this specific EGFR exon 19 deletion demonstrated a partial response to gefitinib with prolonged time to progression (22+ months) and overall survival (22+ months), consistent with an activating EGFR kinase domain mutation. Additional in vitro functional characterization of related exon 19 deletions (del L747-S752) by Pao et al. 2004 (PMID:15329413) demonstrated altered EGFR phosphorylation and increased sensitivity to tyrosine kinase inhibitors, confirming gain-of-function for this class of deletion. OncoKB classifies the variant as Oncogenic with gain-of-function effect, and the variant is recurrently observed in somatic cancers (COSMIC, n=87).
The variant deletes amino acids 746-752 within the EGFR tyrosine kinase domain, a well-characterized critical functional domain. This region encompasses the ATP-binding pocket and is a recognized hotspot for activating oncogenic mutations in non-small-cell lung cancer. In-frame deletions in this region (exon 19, codons 746-759) are recurrently described as gain-of-function alterations in the literature. The variant removes the conserved LREA motif (codons 747-750), known to be critical for kinase regulation.
The variant is absent from all population databases including gnomAD v2.1 (exomes), gnomAD v4.1 (exomes), and gnomAD-Canada v1.0, consistent with a rare variant not observed in the general population (allele frequency <0.1%).
The variant is an in-frame deletion of 7 amino acids (E746-S752) with insertion of a single valine residue within the EGFR kinase domain. This protein length change occurs in a non-repeat region and removes critical residues of the ATP-binding pocket. In-frame deletions in non-repeat regions are recognized as likely disruptive to protein structure and function per ACMG guidelines.
No benign criterion marked as applied in the recorded assessment.
gene-specific framework lacked a usable explicit final combination framework, so generic ACMG/AMP 2015 final-combination rules were applied as fallback; applied criteria: PS3 moderate, PM1 moderate, PM2 supporting, PM4 moderate; combination = 3 moderate + 1 supporting, which maps to Likely Pathogenic.
Evidence summaries and captured source records, where available. Missing entries should not be interpreted as negative findings.
gnomAD v4.1 allele counts were not recorded for this variant.
Absent from gnomAD v2.1.
Absent from gnomAD-Canada v1.0.
Recorded SpliceAI maximum delta score: 0.130. Refer to the recorded PP3/BP4 rationale for interpretation.
1 drug response · 1 Likely pathogenic. ClinVar API review status: no assertion criteria provided.
OncoKB identified variant-specific curated literature and context relevant to functional review; biological-effect context: Gain-of-function; curated oncogenicity label: Oncogenic.
This variant has previously been reported in somatic cancers (COSMIC; COSV51765862, n = 87 times).
This variant does not lie in a statistically significant hotspot.
ACMG/AMP criteria under Not recorded, with the data and sources behind each one.
29 criteria with recorded statuses: 4 met · 7 not met · 9 not assessed · 9 not applicable. Open any row for the full reasoning, the rule and the evidence behind it.
The variant NM_005228.4:c.2237_2255delinsT (p.E746_S752delinsV) is an in-frame deletion-insertion in exon 19 of the EGFR tyrosine kinase domain, removing amino acids 746-752 and inserting a valine residue, which eliminates the conserved LREA motif critical for kinase autoinhibition.
Functional evidence demonstrates this variant causes gain-of-function EGFR kinase activation: the exact variant (del E746-S752insV) was associated with clinical gefitinib response in a lung adenocarcinoma patient (PMID:15710947), and related exon 19 deletions were shown in vitro to alter EGFR phosphorylation and confer TKI sensitivity (PMID:15329413). OncoKB classifies the variant as Oncogenic with gain-of-function effect.
The variant is located in the EGFR tyrosine kinase domain, a well-characterized critical functional domain that is a recurrent hotspot for activating mutations in NSCLC. The deletion removes the conserved LREA motif at codons 747-750 within the ATP-binding pocket.
The variant is absent from all population databases including gnomAD v2.1, v4.1, and gnomAD-Canada v1.0, consistent with a rare variant not tolerated in the general population.
This in-frame deletion of 7 amino acids with insertion of a valine in a non-repeat, critical functional domain constitutes a significant protein length alteration expected to disrupt domain architecture.
The variant has been repeatedly observed as a somatic driver in lung adenocarcinoma (COSMIC, n=87) and is recognized in the curated OncoKB database as oncogenic, underscoring its established functional significance in cancer biology.
Met criteria: PS3 (moderate), PM1 (moderate), PM4 (moderate), PM2 (supporting). Three moderate and one supporting criterion meet the generic ACMG/AMP 2015 threshold for Likely Pathogenic classification.
No criteria match.
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Every interpreted variant in EGFR, mapped onto the exon structure of NM_005228.4. Select a row to find it on the plot.
| Protein | Location | Classification | Link |
|---|
Absent from gnomAD v4.1.
Absent from gnomAD v2.1.
Absent from gnomAD-Canada v1.0.
No further detail was recorded.
SpliceAI predicts no significant splice impact for this variant (max delta score = 0.13).
6 paper records listed. 4 cited in the classification.
Four tumors had in-frame deletions, removing amino acids 746 through 750 (delE746-A750) in Patient 1, 747 through 751 (delL747-T751insS) in Patient 2, and 747 through 753 (delL747-P753insS) in Patients 3 and 4.
Location Table 2 and Results section; all listed exon 19 deletions are delE746-A750, delL747-T751insS, and delL747-P753insS
Context In vitro EGFR autophosphorylation assay in Cos-7 cells with delL747-P753insS and L858R mutant constructs
Ten tumors carried one of two overlapping 15-nucleotide deletions eliminating EGFR codons 746 to 750, starting at nucleotide 2235 or 2236 (Del-1).
Location Results section describing deletions in codons 746-759; Table S2 lists specific variants
Context Gefitinib sensitivity assay in H3255 cell line (L858R mutant), not directly testing exon 19 deletions
the del L747-S752 mutant also induced markedly low levels of phosphotyrosine
Location Table 1 (del L747-S752 in patient G3); Results sections describing in vitro characterization of del L747-S752 mutant
Context Transient transfection in Cos-7 cells and 293T cells, EGFR phosphorylation assay with Western blot, gefitinib sensitivity testing
del 2238-2255, 2237A>T ... del E746-S752insV
Location Table 3, Patient 1; Discussion paragraph describing exon 19 deletions between E746 and P753
Context Clinical response assessment; gefitinib 250 mg daily in advanced NSCLC; EGFR mutation analysis by DNA sequencing of exons 18, 19, 21, 23
Screenshots represent source records captured during evidence collection. Select one to view the recorded source content.
The evidence statements recorded by the interpretation pipeline. They have not been reinterpreted by the page.
Absent from gnomAD v4.1.
Absent from gnomAD v2.1.
Absent from gnomAD-Canada v1.0.
This variant has been reported in ClinVar as drug response (1 clinical laboratory) and as Likely pathogenic (1 clinical laboratory). (ClinVarID = 177652)
SpliceAI predicts no significant splice impact for this variant (max delta score = 0.13).
OncoKB identified variant-specific curated literature and context relevant to functional review; biological-effect context: Gain-of-function; curated oncogenicity label: Oncogenic.
This variant does not lie in a statistically significant hotspot. This variant has previously been reported in somatic cancers (COSMIC; COSV51765862, n = 87 times).
This variant does not lie in a statistically significant hotspot.