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Updated: Dec 25, 2025
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Biopsy on progression in patients with EGFR mutation-positive advanced non-small-cell lung cancer-a Canadian
Background:
Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are standard therapy for patients with advanced or metastatic non-small-cell lung cancer harbouring an EGFR mutation. Upon progression, 50%-60% develop a secondary T790M mutation. Recent trials demonstrated outcome improvement with osimertinib compared with standard platinum-based chemotherapy as second-line therapy for patients with secondary T790M mutation. To identify T790M, a biopsy of the tumour or, more recently, plasma is necessary. This retrospective study aimed to evaluate biopsy procedures and mutational analysis at 2 Canadian cancer centres.
Methods:
In a retrospective review of patients who were approached to enrol in the aura2, aura3, or astris studies, demographics, eligibility for rebiopsy upon progression after an egfr tki, rebiopsy methods and complications, number of rebiopsies, and incidence of the T790M mutation were collected.
Results:
Of 84 patients considered for trial enrolment, 80 signed a consent. In 78 patients who underwent rebiopsy, computed tomography or ultrasonography guidance were the most common methods used. The most common biopsy sites were lung and lymph nodes. The median number of rebiopsies performed to find a T790M mutation was 2. Only 9% of patients experienced complications. Of samples obtained, 74% were adequate for testing after initial rebiopsy. A T790M mutation was found in 47 patients, of whom 44 were enrolled on a trial. After multiple rebiopsies, only 5% of samples were inadequate for molecular analysis.
Conclusions:
In the Canadian setting, the acceptance of rebiopsy on progression was high. Multiple rebiopsies were clinically feasible and could increase the yield for T790M mutation. The incidence of complications was low despite the most common site for rebiopsy being lung.
Insights
Rebiopsy is a feasible method to detect the T790M mutation in non-small cell lung cancer patients progressing on EGFR TKIs. Multiple biopsies increase mutation detection rates with a low complication incidence.
Area of Science:
- Oncology
- Molecular Biology
- Medical Diagnostics
Background:
- Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are standard treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations.
- Secondary T790M mutations develop in 50%-60% of patients upon progression, necessitating alternative treatment strategies.
- Osimertinib has shown improved outcomes compared to chemotherapy for patients with T790M mutations.
Purpose of the Study:
- To evaluate the feasibility and outcomes of rebiopsy procedures for T790M mutation detection in Canadian cancer centers.
- To assess the rate of T790M mutation detection and complications associated with rebiopsy in NSCLC patients.
Main Methods:
- Retrospective review of patients considered for clinical trials (aura2, aura3, astris) after progression on EGFR TKIs.
- Collection of data on demographics, rebiopsy eligibility, methods, complications, and T790M mutation incidence.
- Analysis of rebiopsy procedures, including imaging guidance and biopsy sites (lung, lymph nodes).
Main Results:
- 80 out of 84 patients consented to rebiopsy, with 78 undergoing the procedure.
- Computed tomography (CT) or ultrasonography guidance was most common; lung and lymph nodes were frequent biopsy sites.
- A median of 2 rebiopsies were needed to detect T790M, found in 47 patients. Only 9% experienced complications, and 74% of initial samples were adequate for testing.
Conclusions:
- Rebiopsy for T790M mutation detection is highly accepted and clinically feasible in the Canadian setting.
- Multiple rebiopsies can increase the yield of T790M mutation detection.
- Rebiopsy procedures, even in the lung, have a low incidence of complications.
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