First and repeat rebiopsy for detecting EGFR T790M mutation in non-small-cell lung cancer: CS-Lung-003 prospective observational registry study
First and repeat rebiopsy for detecting EGFR T790M mutation in non-small-cell lung cancer: CS-Lung-003 prospective observational registry study
复制标题
DOI：
10.1007/s00432-021-03893-z
复制
发表时间：
2022-04-06
影响因子：
3.6
通讯作者：
Kiura, Katsuyuki
中科院分区：
文献类型：
--
作者：
Kudo, Kenichiro;Nishii, Kazuya;Kiura, Katsuyuki
目的奥希替尼对表皮生长因子受体（EGFR）-T790 M阳性非小细胞肺癌（NSCLC）的治疗仍然是必需的，即使在复发的情况下，这表明重新活检的重要性。对于首次活检T790 M阴性的NSCLC患者，重复活检的临床价值尚不清楚。在这项研究中，我们检查了第一次再活检的状态，并评估了第一次再活检检测到的T790 M阴性肿瘤的重复再活检频率。方法我们回顾了144例携带主要EGFR突变但未携带T790 M突变的NSCLC患者，这些患者接受了第一代或第二代EGFR酪氨酸激酶抑制剂（TKI）治疗，这些患者在前瞻性伞形型肺癌患者登记研究（CS-Lung-003）中登记。结果63例患者（44%）接受了首次活检。在第一次再活检中，63例患者中分别有51例（81%）和12例（19%）接受了组织学/细胞学再活检和液体活检。在重复活检中，27例患者中分别有23例（85%）和4例（15%）接受了组织学/细胞学再活检和液体活检。最常见的再活检部位是肺部病变（n = 24，38.7%）。总体而言，63例患者中有29例（46.0%）携带T790 M突变。有趣的是，癌细胞的高检出率并不一定表明T790 M突变的高检出率（p < 0.01）。在34例首次再活检确认为T790 M阴性肿瘤的患者中，20例（58.8%）在间隔治疗后进行了重复再活检，显示7例（36.8%）为T790 M阳性肿瘤。在首次再活检和重复再活检检测到790 M突变的患者中，奥希替尼的中位无进展生存期分别为11.8和16.2个月。结论在我们的前瞻性队列研究中，46%接受首次再活检的患者检测到T790 M突变。重复活检可提高T790 M突变检出率。
Purpose Osimertinib is still essential for the treatment of epidermal growth factor receptor (EGFR)-T790M-positive non-small-cell lung cancer (NSCLC) even in a relapsed setting, which suggests the importance of rebiopsy. The clinical value of repeat rebiopsy in patients with NSCLC who are T790M-negative on a first rebiopsy remains unclear. In this study, we examined the status of the first rebiopsy and evaluated the frequency of repeat rebiopsy of T790M-negative tumors detected by the first rebiopsy. Methods We reviewed 144 patients with NSCLC with major EGFR mutations, but not T790M, who received first- or second-generation EGFR tyrosine kinase inhibitors (TKIs), registered in the prospective, umbrella-type lung cancer patient registry (CS-Lung-003). Results Overall, 63 patients (44%) underwent the first rebiopsy. In the first rebiopsy, 51 (81%) and 12 (19%) of 63 underwent histological/cytological rebiopsy and liquid biopsy with the blood sampling, respectively. In the repeat rebiopsy, 23 (85%) and 4 (15%) of 27 underwent histological/cytological rebiopsy and liquid biopsy, respectively. The most frequently rebiopsied site was a pulmonary lesion (n = 24, 38.7%). Overall, 29 (46.0%) of 63 patients harbored the T790M mutation. Interestingly, a high detection rate of cancer cells did not necessarily indicate a high detection rate of the T790M mutation (p < 0.01). Among 34 patients with T790M-negative tumors confirmed on the first rebiopsy, 20 (58.8%) underwent repeat rebiopsies following interval therapy, revealing that seven (36.8%) had T790M-positive tumors. Osimertinib yielded median progression-free survival of 11.8 and 16.2 months in patients with the 790M mutation detected by the first rebiopsy and repeat rebiopsy, respectively. Conclusion In our prospective cohort, the T790M mutation was detected in 46% of patients who underwent the first rebiopsy. Repeat rebiopsy may increase the ability to detect the T790M mutation positivity rate.