Abstract
BackgroundOsimertinib, the third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has become the standard treatment in cases where rebiopsy reveals T790M mutation after the first-line EGFR-TKI treatment. However, the prognosis of patients after rebiopsy, the most important outcome for cancer patients, has not been described sufficiently. This systematic review aimed to clarify whether rebiopsy contributes to improved prognosis in the first- or second-generation EGFR-TKI refractory patients.MethodsUsing free word and control terms related to “non-small cell lung cancer” and “rebiopsy,” we searched studies from Medical Literature Analysis and Retrieval System Online via PubMed, Embase, Cochrane Central Register of Controlled Trials, and World Health Organization International Clinical Trials Registry Platform. We included cohort studies and case reports written in English and judged whether each study answers our research questions.ResultsOf the 144 studies included, only one reported the prognosis of patients with/without rebiopsy showing that in EGFR-TKI refractory non-small cell lung cancer patients, the post-progression survival (PPS) was significantly longer in patients who received rebiopsy and treatment based on a resistant mechanism (median PPS 24.2 months) than those who received rebiopsy and salvage regimen (median PPS 15.2 months, p = 0.002) and who did not receive rebiopsy (median PPS 9.7 months, p < 0.001). Most of the other studies reported the detection rate of T790M mutation or rebiopsy procedure.ConclusionsOnly a few previous studies have investigated the effectiveness of rebiopsy. Hence, further study is needed to determine the prognosis or adverse events of rebiopsy.
Highlights
Osimertinib, the third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-tyrosine kinase inhibitors (TKIs)), has become the standard treatment in cases where rebiopsy reveals T790M mutation after the first-line EGFR-TKI treatment
The key questions (KQs) and the number of articles which answer to each Key question (KQ) are shown the post-progression survival (PPS) was significantly longer in patients who received rebiopsy and treatment based on a resistant mechanism (n = 70, median PPS 24.2 months) than those who received rebiopsy and salvage regimen (n = 37, median PPS 15.2 months, p = 0.002) and who did not receive rebiopsy (n = 120, median PPS 9.7 months, p < 0.001)
In this systematic review, we developed an analytic framework to assess whether performing rebiopsy improves the prognosis in the first- or second-generation EGFR-TKI refractory patients and found several appropriate studies
Summary
Osimertinib, the third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has become the standard treatment in cases where rebiopsy reveals T790M mutation after the first-line EGFR-TKI treatment. A standard care for non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) gene mutation is administration of EGFR-tyrosine kinase inhibitors (TKIs). It has become the standard treatment in cases where rebiopsy reveals T790M mutation after first-line treatment with EGFR-TKIs [6, 7]. After the tumors develop resistance to EGFR-TKIs, rebiopsy of the tissue or liquid biopsy (plasma or urine sampling) [8] to identify T790M mutation plays an important role in deciding the line of treatment [6, 7]
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