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Abhishek Bansal



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    P02 - Diagnostics and Interventional Pulmonology (ID 110)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Diagnostics and Interventional Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P02.02 - Pulmonary Rebiopsy is ‘Here to Stay’ in Non-Small Cell Lung Carcinoma (NSCLC) Patients with Progression on Tyrosine Kinase Inhibitors (TKIs) (ID 3828)

      00:00 - 00:00  |  Presenting Author(s): Abhishek Bansal

      • Abstract
      • Slides

      Introduction

      The discovery of biomarker- driven processes in non small cell lung carcinoma (NSCLC) has caused a dramatic shift in the treatment and prognosis of these patients. Liquid biopsy has emerged as a promising tool for dynamic monitoring of EGFR mutation status to assess the response to EGFR TKIs, with the advantage of high sensitivity. However, resistance eventually ensues; the most common being T790M mutation in exon 20 of the EGFR gene. A rare mechanism is small cell transformation which has been reported in 3% cases, which cannot be detected by liquid biopsy tools. Re-biopsy at progression with histopathologic evaluation is the only modality to detect the same.

      Methods

      This is a retrospective study which included 470 EGFR mutant NSCLC cases between 2015-2019, among whom 260 patients progressed under TKI treatment. Only 78 of these patients were subjected to an image guided re-biopsy.

      Results

      A total of 78 cases underwent an image guided re-biopsy at progression. The tissue was adequate in 72 (92.3%) patients with regards to diagnostic yield, and the re-biopsy procedure was well tolerated without any major complications. However, clinically insignificant pneumothorax was seen in 8 (10.2%) cases. On histomorphologic evaluation, 7 (8.9%) cases were detected to harbor a small cell transformation of NSCLC.

      The median turnaround time for histopathologic evaluation was 72 hours. Among the 78 cases, 41 cases also underwent a simultaneous liquid biopsy for the detection of a T790M mutation, which was positive in 18 cases.

      Conclusion

      From our experience, it is evident that pulmonary tissue re-biopsy at progression should be considered as an essential tool in order to detect small cell change which is missed by sophisticated liquid biopsy tools. Additionally, this has the advantage of better diagnostic yield, comparable turnaround times when compared to liquid biopsy as well as visualization of the ongoing process.

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