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[Search for the T790M mutation: The need to persevere]

H Bourien1, A Lespagnol2, A Prigent3

  • 1Centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France.

Revue Des Maladies Respiratoires
|August 18, 2018
PubMed

Insights

For advanced EGFR-positive lung cancer, T790M mutation testing is crucial for guiding treatment with third-generation EGFR-TKIs. Persistent screening for this resistance mutation is recommended, even after initial negative results.

Area of Science:

  • Oncology
  • Molecular Biology
  • Genetics

Background:

  • First- or second-generation EGFR-tyrosine kinase inhibitors (TKIs) are standard first-line treatments for advanced EGFR mutation-positive non-small cell lung cancer.
  • Disease progression is common, with 50-60% of cases developing resistance due to the T790M mutation.

Observation:

  • Osimertinib (a third-generation EGFR-TKI) is a second-line treatment option, but its use requires T790M mutation identification.
  • This report details 7 cases where identifying the T790M mutation necessitated repeated cell-free DNA and/or biopsy analyses over time.
  • In some instances, a positive T790M result was confirmed significantly after disease progression was noted during first- or second-generation EGFR-TKI therapy.

Findings:

  • Repeated testing for the T790M resistance mutation can yield positive results even after initial negative findings.
  • The timing of T790M mutation detection can be delayed, occurring long after disease progression is clinically evident.

Implications:

  • This highlights the importance of persistent T790M mutation screening in non-small cell lung cancer patients experiencing progression on EGFR-TKIs.
  • Exploring various screening methods for the T790M mutation is encouraged.
  • Perseverance in seeking the T790M mutation is advised when no other resistance mechanisms are identified.
Keywords:
AdenocarcinomaAdénocarcinomeCancer bronchique non à petites cellulesEGFR receptorMutation T790MNon-small cell lung cancerOsimertinibRécepteur à l’EGFT790M mutation

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