Re-biopsy helps to reveal the resistance mechanisms and direct further treatment after resistance to EGFR-TKIs. This study was designed to describe the real-world situation about re-biopsy and reveal the prognosis of patients with advanced non-small lung cancer (NSCLC) failing on first-generation EGFR-TKIs.
Advanced NSCLC patients with initial sensitive EGFR mutations and EGFR-TKI resistance were consecutively reviewed from June, 2011 to July, 2015. The clinical progression model were classified, with genetic resistance mechanisms identified in those received tumor that were re-biopsied. We further compared the post-progression survival (PPS) between different salvage treatments directed by resistant mechanism or clinical progression model after EGFR-TKI failure.
227 cases were included. Among 107 patients (47.1%) who repeated biopsy, no major biopsy-related complications occured. We identified 45 patients (42.1%) with T790M mutation, 15 (14%) patients with C-met amplification. 2 developed SCLC transforming and another 1 presented EMLA4-ALK fusion gene. Patients who received treatment based on a molecular resistant mechanism had longer PPS (n = 70, median PPS: 24.2 [95%CI: 11.0-37.3] months), compared with those who received re-biopsy and salvage regimen based on progression model (n = 37, median PPS: 15.2 [95%CI: 11.2-19.3] months, p = 0.002) and patients who did not receive re-biopsy (n = 120, median PPS: 9.7 [95%CI: 7.0-12.4] months, p
Re-biopsy after EGFR-TKI resistance contributes to identifying resistance mechanism, performing individual salvage treatment and ultimately prolonging post-progression survival.
Clinical trial identification
Legal entity responsible for the study
Sun Yat-sen University Cancer Center
All authors have declared no conflicts of interest.