Bronchoscopic Re-biopsy for Mutational Analysis of Non-small Cell Lung Cancer.

ABSTRACT

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.