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
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Purpose: Standard treatment for cases of non-small cell lung cancer (NSCLC) exhibiting acquired drug resistance includes tumorrebiopsy, epidermal growth factor receptor (EGFR) mutation testing (e.g., for T790M mutations), and the subsequent administrationof third-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs). However, rebiopsies are typically invasive, costly, and occasionallynot feasible. Therefore, the present study aimed to assess rebiopsy procedures by analyzing real-world data collectedby 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 andplasma 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 thesepatients, the greatest majority of whom (43.8%) were subjected to bronchoscopy. T790M mutations were detected in 53.3% of successfullyEGFR-tested rebiopsy samples. A total of 88 patients received osimertinib treatment, and the objective response rate andmedian progression-free survival time was 44.3% and 32.7 weeks, respectively, among the treated patients overall, but 57.8% and45.0 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 plasmasamples.
Abstract
Purpose: Standard treatment for cases of non-small cell lung cancer (NSCLC) exhibiting acquired drug resistance includes tumorrebiopsy, epidermal growth factor receptor (EGFR) mutation testing (e.g., for T790M mutations), and the subsequent administrationof third-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs). However, rebiopsies are typically invasive, costly, and occasionallynot feasible. Therefore, the present study aimed to assess rebiopsy procedures by analyzing real-world data collectedby 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 andplasma 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 thesepatients, the greatest majority of whom (43.8%) were subjected to bronchoscopy. T790M mutations were detected in 53.3% of successfullyEGFR-tested rebiopsy samples. A total of 88 patients received osimertinib treatment, and the objective response rate andmedian progression-free survival time was 44.3% and 32.7 weeks, respectively, among the treated patients overall, but 57.8% and45.0 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 plasmasamples.
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