Chu Q, Agha A, Devost N, Walton R N, Ghosh S, Ho C
Cross Cancer Institute, Alberta Health Services, Edmonton, AB.
BC Cancer-Vancouver Centre, Vancouver, BC.
Curr Oncol. 2020 Feb;27(1):27-33. doi: 10.3747/co.27.5347. Epub 2020 Feb 1.
Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are standard therapy for patients with advanced or metastatic non-small-cell lung cancer harbouring an mutation. Upon progression, 50%-60% develop a secondary T790M mutation. Recent trials demonstrated outcome improvement with osimertinib compared with standard platinum-based chemotherapy as second-line therapy for patients with secondary T790M mutation. To identify T790M, a biopsy of the tumour or, more recently, plasma is necessary. This retrospective study aimed to evaluate biopsy procedures and mutational analysis at 2 Canadian cancer centres.
In a retrospective review of patients who were approached to enrol in the aura2, aura3, or astris studies, demographics, eligibility for rebiopsy upon progression after an egfr tki, rebiopsy methods and complications, number of rebiopsies, and incidence of the T790M mutation were collected.
Of 84 patients considered for trial enrolment, 80 signed a consent. In 78 patients who underwent rebiopsy, computed tomography or ultrasonography guidance were the most common methods used. The most common biopsy sites were lung and lymph nodes. The median number of rebiopsies performed to find a T790M mutation was 2. Only 9% of patients experienced complications. Of samples obtained, 74% were adequate for testing after initial rebiopsy. A T790M mutation was found in 47 patients, of whom 44 were enrolled on a trial. After multiple rebiopsies, only 5% of samples were inadequate for molecular analysis.
In the Canadian setting, the acceptance of rebiopsy on progression was high. Multiple rebiopsies were clinically feasible and could increase the yield for T790M mutation. The incidence of complications was low despite the most common site for rebiopsy being lung.
表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）是携带EGFR突变的晚期或转移性非小细胞肺癌患者的标准治疗方法。疾病进展时，50%-60%的患者会出现继发性T790M突变。近期试验表明，对于发生继发性T790M突变的患者，作为二线治疗，奥希替尼相比标准铂类化疗可改善预后。为了确定T790M突变，需要对肿瘤进行活检，或者最近也可采用血浆检测。这项回顾性研究旨在评估加拿大2家癌症中心的活检程序和突变分析。
回顾性分析拟纳入AURA2、AURA3或ASTRI研究的患者，收集其人口统计学资料、EGFR TKI治疗后疾病进展时再次活检的资格、再次活检方法及并发症、再次活检次数以及T790M突变的发生率。
在84例考虑纳入试验的患者中，80例签署了知情同意书。在78例接受再次活检的患者中，计算机断层扫描或超声引导是最常用的方法。最常见的活检部位是肺和淋巴结。为发现T790M突变而进行的再次活检的中位次数为2次。仅9%的患者出现并发症。在获取的样本中，74%在首次再次活检后足以进行检测。47例患者发现了T790M突变，其中44例纳入了试验。经过多次再次活检后，仅5%的样本无法进行分子分析。
在加拿大，疾病进展时接受再次活检的比例很高。多次再次活检在临床上是可行的，并且可以提高T790M突变的检出率。尽管再次活检最常见的部位是肺，但并发症的发生率较低。
