Yonsei Med J.  2019 Jun;60(6):525-534. 10.3349/ymj.2019.60.6.525.

Real-World Analysis of the Efficacy of Rebiopsy and EGFR Mutation Test of Tissue and Plasma Samples in Drug-Resistant Non-Small Cell Lung Cancer

• Hong MH
• Kim HR
• Ahn BC
• Heo SJ
• Kim JH
• Cho BC

• KMID: 2446957
• DOI: http://doi.org/10.3349/ymj.2019.60.6.525

Abstract

PURPOSE
Standard treatment for cases of non-small cell lung cancer (NSCLC) exhibiting acquired drug resistance includes tumor rebiopsy, epidermal growth factor receptor (EGFR) mutation testing (e.g., for T790M mutations), and the subsequent administration of third-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs). However, rebiopsies are typically invasive, costly, and occasionally not feasible. Therefore, the present study aimed to assess rebiopsy procedures by analyzing real-world data collected by the ASTRIS study of patients with resistant NSCLC.
MATERIALS AND METHODS
The present study used statistical models to evaluate data collected by the ASTRIS trial (NCT02474355) conducted at Yonsei Cancer Center, including the rebiopsy success rate, incidence of T790M mutations in collected tissue and plasma samples, and association of administered osimertinib treatment efficacy.
RESULTS
In a total of 188 screened patients, 112 underwent rebiopsy. An adequate tumor specimen was obtained in 95 of these patients, the greatest majority of whom (43.8%) were subjected to bronchoscopy. T790M mutations were detected in 53.3% of successfully EGFR-tested rebiopsy samples. A total of 88 patients received osimertinib treatment, and the objective response rate and median progression-free survival time was 44.3% and 32.7 weeks, respectively, among the treated patients overall, but 57.8% and 45.0 weeks, and 35.2% and 20.4 weeks among patients who exhibited T790M-positive tissue (n=45) and plasma (n=54) samples, respectively.
CONCLUSION
Approximately 60% of patients in the analyzed real-world cohort were eligible for tissue rebiopsy upon NSCLC progression. Osimertinib activity was higher in patients in whom T790M mutations were detected in tissues rather than in plasma samples.

Keyword

Non-small cell lung cancer; EGFR T790M; rebiopsy; osimertinib; liquid biopsy

MeSH Terms

Bronchoscopy
Carcinoma, Non-Small-Cell Lung*
Cohort Studies
Disease-Free Survival
Drug Resistance
Humans
Incidence
Models, Statistical
Phosphotransferases
Plasma*
Receptor, Epidermal Growth Factor
Treatment Outcome
Phosphotransferases
Receptor, Epidermal Growth Factor

Figure

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  Fig. 1 CONSORT diagram. EGFR, epidermal growth factor receptor.

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  Fig. 2 PFS of patients treated with osimertinib (n=88). Survival curves of patients with documented tissue T790M mutation status (A), with tissue T790M+ versus plasma T790M+ (B), with tissue T790M+ by plasma T790M status (n=45) (C), and with plasma T790M+ by tissue T790M status (n=54) (D). CI, confidence interval; PFS, progression-free survival; HR, hazard ratio.

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