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首页> 外文期刊>BMC Pulmonary Medicine >Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies
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Feasibility of tissue re-biopsy in non-small cell lung cancers resistant to previous epidermal growth factor receptor tyrosine kinase inhibitor therapies

机译：非小细胞肺癌组织再活检的可行性抗性对先前表皮生长因子受体酪氨酸激酶抑制剂治疗方法

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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. 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. 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). 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.
机译：当表皮生长因子受体（EGFR）基因突变阳性非小细胞肺癌（NSCLC）获得对初始酪氨酸激酶抑制剂（TKI）处理的抵抗力时，通过重新活检重新评估肿瘤DNA对于进一步治疗选择是必不可少的。然而，TKI敏感的肿瘤重新进展的过程以及在所有获得性耐药性对EGFR-TKI的所有情况下可以进行重新活组织检查仍然不清楚。我们回顾性地分析了69名连续69名患有EGFR基因突变阳性高级NSCLC的数据，他被EGFR-TKI治疗，并在初始疾病缓解后表现出疾病复发。在重新进展性疾病（Pd）和临床-Pd时鉴定复发病变（当主治医生判断患者作为临床复发和停止EGFR-TKI治疗时）。我们确定了每个复发性病变的潜在重新活组织检查方法，并根据难度和侵袭性标准评估其可行性，如下：A类，通过常规活检技术可访问; B类，难以（但可能）活组织检查和侵入方法可供选择;和C类，在不使用高度侵入性方法的情况下，非常难以活检或无法进入，包括手术活组织检查。重新开始的重新活组织检查（A或B类别）的总可行性率为68％，在临床Pd处为84％，最常见的可接近的复发病变是在临床-Pd的Recist-Pd和胸腔积液处的原发性肿瘤。评估原发性部位（类别A和B类）的所有复发病变被评估为具有重新活组织检查的潜力。然而，在研究人群的大量比例中评估转移的重新活组织检查（分别在RECIST-PD和临床PD）的大量比例中难以评估。在许多情况下，复发疾病的重复活检是可行的，尽管在例如转移性复发病变的情况下可能存在困难。为了促进NSCLC患者的治疗策略复发后EGFR-TKI治疗后，应使用更简单和更可靠的方法标准化重新活组织检查。

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