Re-biopsy confers survival benefit through directing salvage treatment for patients failing prior EGFR-TKIs

Date

08 Oct 2016

Session

Poster Display

Presenters

Li Zhang

Citation

Annals of Oncology (2016) 27 (6): 416-454. 10.1093/annonc/mdw383

Authors

L. Zhang1, J. Sheng2, Y. Huang2, Y. Yang2, H. Zhao2, W. Fang2, Y. Zhao2, Y. Zhang2

Author affiliations

  • 1 Medical Oncology, Sun Yat-sen University Cancer Center, 510060 - Guangzhou/CN
  • 2 State Key Laboratory Of Oncology In South China, Sun Yat-sen University Cancer Center, 510060 - Guangzhou/CN
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Background

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.

Methods

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.

Results

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 

Conclusions

Re-biopsy after EGFR-TKI resistance contributes to identifying resistance mechanism, performing individual salvage treatment and ultimately prolonging post-progression survival.

Clinical trial identification

Not applicable.

Legal entity responsible for the study

Sun Yat-sen University Cancer Center

Funding

AstraZeneca

Disclosure

All authors have declared no conflicts of interest.

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