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Usefulness of Bronchoscopic Rebiopsy of Non-Small Cell Lung Cancer with Acquired Resistance to Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor

 Eun Kyong Goag  ;  Jung Mo Lee  ;  Kyung Soo Chung  ;  Song Yee Kim  ;  Ah Young Leem  ;  Joo Han Song  ;  Ji Ye Jung  ;  Moo Suk Park  ;  Yoon Soo Chang  ;  Young Sam Kim  ;  Joon Chang  ;  Eun Young Kim 
 Journal of Cancer, Vol.9(6) : 1113-1120, 2018 
Journal Title
 Journal of Cancer 
Issue Date
T790M ; epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) ; non-small cell lung cancer (NSCLC) ; rebiopsy
Background: Approximately 50% of non-small cell lung cancer (NSCLC) patients with acquired resistance to EGFR-TKI harbor the EGFR mutation T790M. The recent development and wide use of third-generation EGFR-TKIs targeting T790M-mutant NSCLCs have increased the importance of rebiopsy after EGFR-TKI failure. We aimed to investigate the advantages of flexible bronchoscopy as a rebiopsy method and the prevalence of and factors affecting the T790M mutation after EGFR-TKI failure. Methods: We investigated 139 patients who had undergone bronchoscopic rebiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between Sep 2014 and Jul 2016. Results: Among the 139 patients, bronchoscopic rebiopsy yielded successful pathological diagnoses in 102 (73.4%). Among them, 41 patients with EGFR-mutant lung adenocarcinoma and EGFR-TKI progression were selected for an investigation of T790M mutation prevalence at rebiopsy. The initial EGFR mutations were exon 19 del (56.1%), L858R or L861Q (34.1%), and others (9.8%). The most common rebiopsy method was transbronchial lung biopsy (41.5%), followed by EBUS-TBNA (26.8%) and endobronchial biopsy (19.5%). The median interval to T790M emergence was the longest among cases with exon 19 deletion (14.1 months), followed by exon 21 L858R or L861Q (11.3 months) and other rare EGFR mutations (2.9 months). The T790M mutation was identified in 18 (43.9%) patients, and exon 19 del was the most significant factor affecting T790M mutation development (hazard ratio: 6.875, P = 0.014). Conclusions: Bronchoscopy was more useful than other rebiopsy approaches. The T790M emergence rate was highest in cases with exon 19 deletion, likely as a consequence of long-term EGFR-TKI exposure.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
곽은경(Goag, Eun Kyong)
김송이(Kim, Song Yee) ORCID logo https://orcid.org/0000-0001-8627-486X
김영삼(Kim, Young Sam) ORCID logo https://orcid.org/0000-0001-9656-8482
김은영(Kim, Eun Young)
박무석(Park, Moo Suk) ORCID logo https://orcid.org/0000-0003-0820-7615
송주한(Song, Joo Han)
이정모(Lee, Jung Mo)
임아영(Leem, Ah Young)
장윤수(Chang, Yoon Soo)
장준(Chang, Joon)
정경수(Jung, Kyung Soo)
정지예(Jung, Ji Ye) ORCID logo https://orcid.org/0000-0003-1589-4142
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