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Published on: November 10, 2014
Bronchoscopic Re-biopsy for Mutational Analysis of Non-small Cell Lung Cancer
Keisuke Kirita1,2, Takehiro Izumo3, Yuji Matsumoto1
1Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1, Tukiji Chou-ku, Tokyo, 104-0045, Japan.
Objectives:
Currently, several acquired resistance mechanisms and rare driver oncogenes are identified in non-small cell lung cancer (NSCLC) relapses. Re-biopsy increases valuable information to guide treatment strategies, but the utility and feasibility of bronchoscopic re-biopsy has not been investigated.
Methods:
We studied 70 patients who underwent bronchoscopic for re-biopsy of NSCLC that was resistant to at least one regimen of chemotherapy or molecular-targeted therapy between January 2013 and December 2014. We assessed clinical data, technical success rate, and mutational analysis.
Results:
Procedures performed were transbronchial biopsy (n = 52) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) (n = 18). Overall detection rate of re-biopsy for malignant cells was 87 % (83 % for TBB and 100 % for EBUS-TBNA). Mutational analysis was possible in almost all technically successful cases; likewise, acquired-resistant mutations (55 % of EGFR mutants) and small cell lung cancer transformation were identified from the bronchoscopy specimens. Other driver mutations were seen in four cases, including ALK fusion gene (n = 2) and ROS1 fusion gene (n = 2). There were no associated severe complications.
Conclusion:
This study shows that bronchoscopic re-biopsy for NSCLC is feasible and provides adequate samples that enable identification of resistance mutations and rare driver oncogenes.
Insights
Bronchoscopic re-biopsy is a feasible method for non-small cell lung cancer (NSCLC) relapses. It effectively identifies acquired resistance mutations and rare driver oncogenes, guiding future treatment strategies.
Area of Science:
- Oncology
- Pulmonology
- Medical Diagnostics
Background:
- Non-small cell lung cancer (NSCLC) relapses often involve acquired resistance mechanisms and rare driver oncogenes.
- Re-biopsy can provide crucial information for optimizing treatment strategies in relapsed NSCLC.
- The utility and feasibility of bronchoscopic re-biopsy for NSCLC relapses remain under-investigated.
Purpose of the Study:
- To investigate the feasibility and diagnostic yield of bronchoscopic re-biopsy in patients with relapsed non-small cell lung cancer (NSCLC).
- To assess the ability of bronchoscopic re-biopsy to detect acquired resistance mutations and rare driver oncogenes.
Main Methods:
- A study of 70 patients with NSCLC resistant to prior therapy who underwent bronchoscopic re-biopsy between January 2013 and December 2014.
- Procedures included transbronchial biopsy (TBB) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
- Clinical data, technical success rates, and mutational analysis results were assessed.
Main Results:
- The overall detection rate of malignant cells via bronchoscopic re-biopsy was 87% (83% for TBB, 100% for EBUS-TBNA).
- Mutational analysis was successful in most cases, identifying acquired resistance mutations (55% of EGFR mutants) and rare driver mutations (ALK, ROS1 fusions).
- Small cell lung cancer transformation was also identified; no severe complications occurred.
Conclusions:
- Bronchoscopic re-biopsy is a feasible and safe procedure for patients with relapsed NSCLC.
- The technique provides adequate samples for molecular analysis, aiding in the identification of resistance mechanisms and novel driver oncogenes.
- This approach offers valuable insights for tailoring subsequent treatment regimens in NSCLC.
