Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies

Sakurako Uozu, Kazuyoshi Imaizumi, Teppei Yamaguchi, Yasuhiro Goto, Kenji Kawada, Tomoyuki Minezawa, Takuya Okamura, Ken Akao, Masamichi Hayashi, Sumito Isogai, Mitsushi Okazawa, Naozumi Hashimoto, Yoshinori Hasegawa

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Abstract

BACKGROUND: When epidermal growth factor receptor (EGFR) gene mutation-positive non-small cell lung cancer (NSCLC) acquires resistance to the initial tyrosine kinase inhibitor (TKI) treatment, reassessing the tumor DNA by re-biopsy is essential for further treatment selection. However, the process of TKI-sensitive tumor re-progression and whether re-biopsy is possible in all cases of acquired resistance to EGFR-TKI remain unclear.

METHODS: We retrospectively analyzed data from 69 consecutive patients with EGFR gene mutation-positive advanced NSCLC who had been treated with EGFR-TKI and exhibited disease relapse after initial disease remission. The relapsing lesions were identified at the time of RECIST-progressive disease (PD) and clinical-PD (when the attending physician judged the patient as clinically relapsing and stopped EGFR-TKI therapy). We determined the potential re-biopsy methods for each relapsing lesion and evaluated their feasibility according to difficulty and invasiveness criteria as follows: category A, accessible by conventional biopsy techniques; category B, difficult (but possible) to biopsy and accessible with invasive methods; and category C, extremely difficult to biopsy or inaccessible without using highly invasive methods, including surgical biopsy.

RESULTS: The total feasibility rate of re-biopsy (category A or B) was 68% at RECIST-PD and 84% at clinical-PD, and the most common accessible relapsing lesions were primary tumors at RECIST-PD and pleural effusion at clinical-PD. All relapsing lesions at primary sites (categories A and B) were assessed as having the potential for re-biopsy. However, re-biopsy for metastasis was assessed as difficult in a substantial proportion of the study population (42 and 20% category C at RECIST-PD and clinical-PD, respectively).

CONCLUSIONS: Re-biopsy of relapsing disease is feasible in many cases, although it may present difficulties in cases with, e.g., metastatic relapsing lesions. To facilitate treatment strategies in NSCLC patients with relapse after EGFR-TKI therapy, re-biopsy should be standardized with the use of simpler and more reliable methods.

Original languageEnglish
Number of pages1
JournalBMC pulmonary medicine
Volume17
Issue number1
DOIs
Publication statusPublished - 06-12-2017

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Epidermal Growth Factor Receptor
Non-Small Cell Lung Carcinoma
Protein-Tyrosine Kinases
Biopsy
Therapeutics
erbB-1 Genes
Recurrence
Neoplasms
Mutation
Pleural Effusion
Neoplasm Metastasis
Physicians

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Uozu, Sakurako ; Imaizumi, Kazuyoshi ; Yamaguchi, Teppei ; Goto, Yasuhiro ; Kawada, Kenji ; Minezawa, Tomoyuki ; Okamura, Takuya ; Akao, Ken ; Hayashi, Masamichi ; Isogai, Sumito ; Okazawa, Mitsushi ; Hashimoto, Naozumi ; Hasegawa, Yoshinori. / Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies. In: BMC pulmonary medicine. 2017 ; Vol. 17, No. 1.
@article{bf44e4673c4143bca1736cf43133d397,
title = "Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies",
abstract = "BACKGROUND: When epidermal growth factor receptor (EGFR) gene mutation-positive non-small cell lung cancer (NSCLC) acquires resistance to the initial tyrosine kinase inhibitor (TKI) treatment, reassessing the tumor DNA by re-biopsy is essential for further treatment selection. However, the process of TKI-sensitive tumor re-progression and whether re-biopsy is possible in all cases of acquired resistance to EGFR-TKI remain unclear.METHODS: We retrospectively analyzed data from 69 consecutive patients with EGFR gene mutation-positive advanced NSCLC who had been treated with EGFR-TKI and exhibited disease relapse after initial disease remission. The relapsing lesions were identified at the time of RECIST-progressive disease (PD) and clinical-PD (when the attending physician judged the patient as clinically relapsing and stopped EGFR-TKI therapy). We determined the potential re-biopsy methods for each relapsing lesion and evaluated their feasibility according to difficulty and invasiveness criteria as follows: category A, accessible by conventional biopsy techniques; category B, difficult (but possible) to biopsy and accessible with invasive methods; and category C, extremely difficult to biopsy or inaccessible without using highly invasive methods, including surgical biopsy.RESULTS: The total feasibility rate of re-biopsy (category A or B) was 68{\%} at RECIST-PD and 84{\%} at clinical-PD, and the most common accessible relapsing lesions were primary tumors at RECIST-PD and pleural effusion at clinical-PD. All relapsing lesions at primary sites (categories A and B) were assessed as having the potential for re-biopsy. However, re-biopsy for metastasis was assessed as difficult in a substantial proportion of the study population (42 and 20{\%} category C at RECIST-PD and clinical-PD, respectively).CONCLUSIONS: Re-biopsy of relapsing disease is feasible in many cases, although it may present difficulties in cases with, e.g., metastatic relapsing lesions. To facilitate treatment strategies in NSCLC patients with relapse after EGFR-TKI therapy, re-biopsy should be standardized with the use of simpler and more reliable methods.",
author = "Sakurako Uozu and Kazuyoshi Imaizumi and Teppei Yamaguchi and Yasuhiro Goto and Kenji Kawada and Tomoyuki Minezawa and Takuya Okamura and Ken Akao and Masamichi Hayashi and Sumito Isogai and Mitsushi Okazawa and Naozumi Hashimoto and Yoshinori Hasegawa",
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Uozu, S, Imaizumi, K, Yamaguchi, T, Goto, Y, Kawada, K, Minezawa, T, Okamura, T, Akao, K, Hayashi, M, Isogai, S, Okazawa, M, Hashimoto, N & Hasegawa, Y 2017, 'Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies', BMC pulmonary medicine, vol. 17, no. 1. https://doi.org/10.1186/s12890-017-0514-3

Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies. / Uozu, Sakurako; Imaizumi, Kazuyoshi; Yamaguchi, Teppei; Goto, Yasuhiro; Kawada, Kenji; Minezawa, Tomoyuki; Okamura, Takuya; Akao, Ken; Hayashi, Masamichi; Isogai, Sumito; Okazawa, Mitsushi; Hashimoto, Naozumi; Hasegawa, Yoshinori.

In: BMC pulmonary medicine, Vol. 17, No. 1, 06.12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies

AU - Uozu, Sakurako

AU - Imaizumi, Kazuyoshi

AU - Yamaguchi, Teppei

AU - Goto, Yasuhiro

AU - Kawada, Kenji

AU - Minezawa, Tomoyuki

AU - Okamura, Takuya

AU - Akao, Ken

AU - Hayashi, Masamichi

AU - Isogai, Sumito

AU - Okazawa, Mitsushi

AU - Hashimoto, Naozumi

AU - Hasegawa, Yoshinori

PY - 2017/12/6

Y1 - 2017/12/6

N2 - BACKGROUND: When epidermal growth factor receptor (EGFR) gene mutation-positive non-small cell lung cancer (NSCLC) acquires resistance to the initial tyrosine kinase inhibitor (TKI) treatment, reassessing the tumor DNA by re-biopsy is essential for further treatment selection. However, the process of TKI-sensitive tumor re-progression and whether re-biopsy is possible in all cases of acquired resistance to EGFR-TKI remain unclear.METHODS: We retrospectively analyzed data from 69 consecutive patients with EGFR gene mutation-positive advanced NSCLC who had been treated with EGFR-TKI and exhibited disease relapse after initial disease remission. The relapsing lesions were identified at the time of RECIST-progressive disease (PD) and clinical-PD (when the attending physician judged the patient as clinically relapsing and stopped EGFR-TKI therapy). We determined the potential re-biopsy methods for each relapsing lesion and evaluated their feasibility according to difficulty and invasiveness criteria as follows: category A, accessible by conventional biopsy techniques; category B, difficult (but possible) to biopsy and accessible with invasive methods; and category C, extremely difficult to biopsy or inaccessible without using highly invasive methods, including surgical biopsy.RESULTS: The total feasibility rate of re-biopsy (category A or B) was 68% at RECIST-PD and 84% at clinical-PD, and the most common accessible relapsing lesions were primary tumors at RECIST-PD and pleural effusion at clinical-PD. All relapsing lesions at primary sites (categories A and B) were assessed as having the potential for re-biopsy. However, re-biopsy for metastasis was assessed as difficult in a substantial proportion of the study population (42 and 20% category C at RECIST-PD and clinical-PD, respectively).CONCLUSIONS: Re-biopsy of relapsing disease is feasible in many cases, although it may present difficulties in cases with, e.g., metastatic relapsing lesions. To facilitate treatment strategies in NSCLC patients with relapse after EGFR-TKI therapy, re-biopsy should be standardized with the use of simpler and more reliable methods.

AB - BACKGROUND: When epidermal growth factor receptor (EGFR) gene mutation-positive non-small cell lung cancer (NSCLC) acquires resistance to the initial tyrosine kinase inhibitor (TKI) treatment, reassessing the tumor DNA by re-biopsy is essential for further treatment selection. However, the process of TKI-sensitive tumor re-progression and whether re-biopsy is possible in all cases of acquired resistance to EGFR-TKI remain unclear.METHODS: We retrospectively analyzed data from 69 consecutive patients with EGFR gene mutation-positive advanced NSCLC who had been treated with EGFR-TKI and exhibited disease relapse after initial disease remission. The relapsing lesions were identified at the time of RECIST-progressive disease (PD) and clinical-PD (when the attending physician judged the patient as clinically relapsing and stopped EGFR-TKI therapy). We determined the potential re-biopsy methods for each relapsing lesion and evaluated their feasibility according to difficulty and invasiveness criteria as follows: category A, accessible by conventional biopsy techniques; category B, difficult (but possible) to biopsy and accessible with invasive methods; and category C, extremely difficult to biopsy or inaccessible without using highly invasive methods, including surgical biopsy.RESULTS: The total feasibility rate of re-biopsy (category A or B) was 68% at RECIST-PD and 84% at clinical-PD, and the most common accessible relapsing lesions were primary tumors at RECIST-PD and pleural effusion at clinical-PD. All relapsing lesions at primary sites (categories A and B) were assessed as having the potential for re-biopsy. However, re-biopsy for metastasis was assessed as difficult in a substantial proportion of the study population (42 and 20% category C at RECIST-PD and clinical-PD, respectively).CONCLUSIONS: Re-biopsy of relapsing disease is feasible in many cases, although it may present difficulties in cases with, e.g., metastatic relapsing lesions. To facilitate treatment strategies in NSCLC patients with relapse after EGFR-TKI therapy, re-biopsy should be standardized with the use of simpler and more reliable methods.

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U2 - 10.1186/s12890-017-0514-3

DO - 10.1186/s12890-017-0514-3

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