Kaname Nosaki1, Miyako Satouchi2, Takayasu Kurata3, Tatsuya Yoshida4, Isamu Okamoto5, Nobuyuki Katakami6, Fumio Imamura7, Kaoru Tanaka8, Yuki Yamane9, Nobuyuki Yamamoto10, Terufumi Kato11, Katsuyuki Kiura12, Hideo Saka13, Hiroshige Yoshioka14, Kana Watanabe15, Keiko Mizuno16, Takashi Seto17. 1. National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. 2. Hyogo Cancer Center, Hyogo, Japan. 3. Kansai Medical University Hospital, Osaka, Japan. 4. Aichi Cancer Center Hospital, Nagoya, Japan. 5. Kyushu University Hospital, Fukuoka, Japan. 6. Institute of Biomedical Research and Innovation, Kobe, Japan. 7. Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 8. Kindai University, Faculty of Medicine, Osaka, Japan. 9. Saitama Cancer Center, Saitama, Japan. 10. Wakayama Medical University, Wakayama, Japan. 11. Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan (Kanagawa Cancer Center, since April 2016）. 12. Okayama University Hospital, Okayama, Japan. 13. Nagoya Medical Center, Nagoya, Japan. 14. Kurashiki Central Hospital, Kurashiki, Japan. 15. Miyagi Cancer Center, Natori, Japan. 16. Kagoshima University Hospital, Kagoshima, Japan. 17. National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. Electronic address: tseto@nk-cc.go.jp.
Abstract
OBJECTIVE: Disease progression because of acquired resistance is common in advanced or metastatic epidermal growth factor receptor (EGFR)-mutation positive non-small cell lung cancer (NSCLC), despite initial response to EGFR-tyrosine kinase inhibitors (TKIs). In Japan, transbronchial tissue biopsy is the most common sampling method used for re-biopsy to identify patients eligible for treatment. We aimed to investigate the success rate of re-biopsy and re-biopsy status of patients with advanced or metastatic NSCLC completing first-line EGFR-TKI therapy. PATIENTS AND METHODS: This was a retrospective, multi-center, Japanese study. The target patients in the study were EGFR mutation-positive NSCLC patients. The primary endpoint was the success rate (number of cases in which tumor cells were detected/total number of re-biopsies performed×100). Secondary endpoints included differences between the status of the first biopsy and that of the re-biopsy in the same patient population, and the details of cases in which re-biopsy could not be carried out. Re-biopsy-associated complications were also assessed. RESULTS: Overall, 395 patients were evaluated (median age 63 years), with adenocarcinoma being the most common tumor type. Re-biopsy was successful in 314 patients (79.5%). Compared with the sampling method at first biopsy, at re-biopsy, the surgical resection rate increased from 1.8% to 7.8%, and percutaneous tissue biopsy increased from 7.6% to 29.1%, suggesting the difficulty of performing re-biopsy. Approximately half of the patients had T790M mutations, which involved a Del19 mutation in 55.6% of patients and an L858R mutation in 43.0%. Twenty-three patients (5.8%) had re-biopsy- associated complications, most commonly pneumothorax. CONCLUSIONS: Success rate for re-biopsy in this study was approximately 80%. Our study sheds light on the re-biopsy status after disease progression in patients with advanced or metastatic NSCLC. This information is important to improve the selection of patients who may benefit from third-generation TKIs.
OBJECTIVE: Disease progression because of acquired resistance is common in advanced or metastatic epidermal growth factor receptor (EGFR)-mutation positive non-small cell lung cancer (NSCLC), despite initial response to EGFR-tyrosine kinase inhibitors (TKIs). In Japan, transbronchial tissue biopsy is the most common sampling method used for re-biopsy to identify patients eligible for treatment. We aimed to investigate the success rate of re-biopsy and re-biopsy status of patients with advanced or metastatic NSCLC completing first-line EGFR-TKI therapy. PATIENTS AND METHODS: This was a retrospective, multi-center, Japanese study. The target patients in the study were EGFR mutation-positive NSCLCpatients. The primary endpoint was the success rate (number of cases in which tumor cells were detected/total number of re-biopsies performed×100). Secondary endpoints included differences between the status of the first biopsy and that of the re-biopsy in the same patient population, and the details of cases in which re-biopsy could not be carried out. Re-biopsy-associated complications were also assessed. RESULTS: Overall, 395 patients were evaluated (median age 63 years), with adenocarcinoma being the most common tumor type. Re-biopsy was successful in 314 patients (79.5%). Compared with the sampling method at first biopsy, at re-biopsy, the surgical resection rate increased from 1.8% to 7.8%, and percutaneous tissue biopsy increased from 7.6% to 29.1%, suggesting the difficulty of performing re-biopsy. Approximately half of the patients had T790M mutations, which involved a Del19 mutation in 55.6% of patients and an L858R mutation in 43.0%. Twenty-three patients (5.8%) had re-biopsy- associated complications, most commonly pneumothorax. CONCLUSIONS: Success rate for re-biopsy in this study was approximately 80%. Our study sheds light on the re-biopsy status after disease progression in patients with advanced or metastatic NSCLC. This information is important to improve the selection of patients who may benefit from third-generation TKIs.
Authors: Hyungjin Kim; Kum Ju Chae; Soon Ho Yoon; Miso Kim; Bhumsuk Keam; Tae Min Kim; Dong-Wan Kim; Jin Mo Goo; Chang Min Park Journal: Eur Radiol Date: 2017-08-07 Impact factor: 5.315