Division of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, Kobe, Japan.
Division of Radiology, Kobe Minimally Invasive Cancer Center, Kobe, Japan.
Thorac Cancer. 2021 Mar;12(6):746-751. doi: 10.1111/1759-7714.13822. Epub 2021 Jan 21.
Indication for treatment with osimertinib after first/second generation (1/2G) epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance depends on T790M mutation detected by rebiopsy. The aim of our study was to analyze the data on clinical practice at our hospital where histological rebiopsy is actively carried out multiple times.
We retrospectively reviewed our electronic medical records of EGFR-mutant non-small cell lung cancer (NSCLC) patients to examine clinical rebiopsy situation, T790M detection rate, osimertinib introduction rate and associated outcomes.
Among 95 patients with EGFR-mutant NSCLC, 72 patients received 1/2G EGFR-TKIs. Of 60 with progressive disease on 1/2G EGFR-TKIs, 50 (83%) underwent rebiopsy. T790M was detected in 40 (80%) of 50, resulting in a 79% osimertinib introduction rate, as one patient refused osimertinib. T790M was detected by first rebiopsy in 18 (36%) of 50 patients, and by second or subsequent rebiopsy in 22 (44%). Median time to treatment failure of T790M-positive patients at first rebiopsy was 22.6 (95% confidence interval [CI]: 10.2-32.8) months, and those at multiple repeated rebiopsy was 20.9 (95% CI: 8.6-not reached) months (p = 0.64). Median overall survival (OS) in osimertinib introduced group was 92.5 (95% CI: 62.9-not reached), while in nonosimertinib median OS was 39.0 months (95% CI: 22.2-not reached) (p = 0.04).
T790M detection rate was increased by multiple repeated rebiopsy, achieving a higher osimertinib introduction rate. This higher introduction rate could contribute to better prognosis of EGFR-mutant NSCLC patients.
在第一代/第二代（1/2G）表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）耐药后，使用奥希替尼进行治疗的适应证取决于通过再次活检检测到的 T790M 突变。我们研究的目的是分析我们医院的临床实践数据，在我们医院中积极进行多次组织学再次活检。
我们回顾性地审查了我们的电子病历，以检查 EGFR 突变型非小细胞肺癌（NSCLC）患者的临床再次活检情况、T790M 检测率、奥希替尼引入率以及相关结局。
在 95 名 EGFR 突变型 NSCLC 患者中，72 名患者接受了 1/2G EGFR-TKIs 治疗。在 60 名接受 1/2G EGFR-TKI 治疗后疾病进展的患者中，有 50 名（83%）进行了再次活检。在 50 名患者中，有 40 名（80%）检测到 T790M，奥希替尼的引入率为 79%，因为有 1 名患者拒绝接受奥希替尼治疗。在 50 名患者中，有 18 名（36%）通过首次再次活检检测到 T790M，22 名（44%）通过第二次或后续再次活检检测到 T790M。首次再次活检中 T790M 阳性患者的中位治疗失败时间为 22.6（95%置信区间[CI]：10.2-32.8）个月，而多次重复再次活检的患者为 20.9（95%CI：8.6-未达到）个月（p = 0.64）。奥希替尼引入组的中位总生存期（OS）为 92.5（95%CI：62.9-未达到），而非奥希替尼组的中位 OS 为 39.0 个月（95%CI：22.2-未达到）（p = 0.04）。
通过多次重复再次活检提高了 T790M 的检测率，从而提高了奥希替尼的引入率。更高的引入率可能有助于改善 EGFR 突变型 NSCLC 患者的预后。
