Saturation mutagenesis identifies activating and resistance-inducing FGFR kinase domain mutations
Variants of uncertain significance represent the biggest challenge for genomics-based precision oncology. Activated fibroblast growth factor receptors (FGFRs) frequently drive tumorigenesis by different genetic aberrations. However, it remains unknown which of the many point mutations affecting FGFR1, FGFR2, FGFR3 or FGFR4 in cancer are druggable, that is, activating signaling while not mediating FGFR inhibitor resistance. Here we implemented a saturation mutational scanning platform to screen all 11,520 possible point mutations covering the kinase domains of FGFR1-4. Pooled positive selection screens identified 474 activating and 738 mutations mediating resistance to the FGFR inhibitors pemigatinib and futibatinib, together revealing 301 druggable FGFR mutations analogous to a strong PS3/BS3 evidence level. The screens also identified loss-of-function mutations and an association of gain-of-function mutations with hydrophobic changes. The functional screens identified 97% of acquired resistance mutations in clinical trials. Our comprehensive catalog of every druggable mutation in the FGFR kinase domains is readily available for clinical decision support.
Authors
- Martin Ziegler (ORCID: https://orcid.org/0000-0003-2137-5234)
- Avantika Ghosh (ORCID: https://orcid.org/0009-0000-2172-3791)
- Melanie Boerries (ORCID: https://orcid.org/0000-0002-3670-0602)
- Sonja Loges (ORCID: https://orcid.org/0000-0002-7650-8527)
- Luc Friboulet (ORCID: https://orcid.org/0000-0002-1129-4978)
- Andreas Wanninger (ORCID: https://orcid.org/0000-0002-3266-5838)
- Yohann Loriot (ORCID: https://orcid.org/0000-0002-8338-1739)
- Tilman Brummer (ORCID: https://orcid.org/0000-0003-4387-7905)
- Marisa Riester (ORCID: https://orcid.org/0009-0006-4178-1685)
- J. Jesús Naveja (ORCID: https://orcid.org/0000-0001-8640-6690)
- Sven Diederichs (ORCID: https://orcid.org/0000-0001-7901-4752)
- Maria Elena Hess (ORCID: https://orcid.org/0009-0007-5792-3657)
- Carla Schmidt (ORCID: https://orcid.org/0000-0002-4715-4985)
- Antoine Hollebecque (ORCID: https://orcid.org/0000-0003-2869-7551)
- Francesco Facchinetti
- Anna Lena Illert
- Jannis Stappenbeck
- Luise Carmina Viardot
- Tobias Zundel
- Yagmur Oyku Carus Sahin (ORCID: https://orcid.org/0009-0008-3881-6140)
Institutions
- Inserm (FR)
- University of Freiburg (DE)
- German Cancer Research Center (DE)
- Johannes Gutenberg University Mainz (DE)
- Heidelberg University (DE)
- Université Paris-Saclay (FR)
- University Medical Center Freiburg (DE)
- Institut Gustave Roussy (FR)
- University Hospital Heidelberg (DE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Universitätsmedizin Göttingen (DE)
- German Centre for Cardiovascular Research (DE)
- Institute of Molecular Biology (DE)
- Technical University of Munich (DE)
Publication Details
- Journal
- Nature Genetics
- Published
- 2025-12-08
- DOI
- https://doi.org/10.1038/s41588-025-02431-8
- Citations
- 3
- Primary Topic
- Fibroblast Growth Factor Research
- Type
- article
- Field-Weighted Citation Impact
- 2.42
Funders
- Strong
- European Commission
- Deutsche Forschungsgemeinschaft
- Bundesministerium für Bildung und Forschung
- Albert-Ludwigs-Universität Freiburg
- Université de Fribourg
- Deutsche Krebshilfe
- Deutschen Konsortium für Translationale Krebsforschung