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BMC Cancer

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Open Access 01-12-2018 | Case report

Effective osimertinib treatment in a patient with discordant T790 M mutation detection between liquid biopsy and tissue biopsy

Authors: Isa Mambetsariev, Lalit Vora, Kim Wai Yu, Ravi Salgia

Published in: BMC Cancer | Issue 1/2018

Abstract

Background

We report the successful treatment of the patient with osimertinib 80 mg/day following disease progression and a discordance in the detection of a mechanism of resistance epithelial growth factor receptor (EGFR) T790 M between liquid biopsy and tissue biopsy methods.

Case presentation

A 57-year-old Hispanic male patient initially diagnosed with an EGFR 19 deletion positive lung adenocarcinoma and clinically responded to initial erlotinib treatment. The patient subsequently progressed on erlotinib 150 mg/day and repeat biopsies both tissue and liquid were sent for next-generation sequencing (NGS). A T790 M EGFR mutation was detected in the blood sample using a liquid biopsy technique, but the tissue biopsy failed to show a T790 M mutation in a newly biopsied tissue sample. He was then successfully treated with osimertinib 80 mg/day, has clinically and radiologically responded, and remains on osimertinib treatment after 10 months.

Conclusions

Second-line osimertinib treatment, when administered at 80 mg/day, is both well tolerated and efficacious in a patient with previously erlotinib treated lung adenocarcinoma and a T790 M mutation detected by liquid biopsy.

Cancer Genome Atlas Research N. Comprehensive molecular profiling of lung adenocarcinoma. Nature. 2014;511(7511):543–50. https://doi.org/10.1038/nature13385. PubMed PMID: 25079552; PMCID: 4231481CrossRef

Lynch TJ, Bell DW, Sordella R, Gurubhagavatula S, Okimoto RA, Brannigan BW, Harris PL, Haserlat SM, Supko JG, Haluska FG, Louis DN, Christiani DC, Settleman J, Haber DA. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350(21):2129–39. https://doi.org/10.1056/NEJMoa040938. PubMed PMID: 15118073CrossRefPubMed

Gazdar AF. Activating and resistance mutations of EGFR in non-small-cell lung cancer: role in clinical response to EGFR tyrosine kinase inhibitors. Oncogene. 2009;28(Suppl 1):S24–31. https://doi.org/10.1038/onc.2009.198. PubMed PMID: 19680293; PMCID: 2849651CrossRefPubMedPubMedCentral

Ladanyi M, Pao W. Lung adenocarcinoma: guiding EGFR-targeted therapy and beyond. Mod Pathol. 2008;21(Suppl 2):S16–22. https://doi.org/10.1038/modpathol.3801018. PubMed PMID: 18437168CrossRefPubMed

Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, Campos D, Maoleekoonpiroj S, Smylie M, Martins R, van Kooten M, Dediu M, Findlay B, Tu D, Johnston D, Bezjak A, Clark G, Santabarbara P, Seymour L, National Cancer Institute of Canada Clinical Trials G. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123–32. https://doi.org/10.1056/NEJMoa050753. PubMed PMID: 16014882CrossRefPubMed

Stinchcombe TE, Socinski MA. Gefitinib in advanced non-small cell lung cancer: does it deserve a second chance? Oncologist. 2008;13(9):933–44. https://doi.org/10.1634/theoncologist.2008-0019. PubMed PMID: 18784157 CrossRefPubMed

Thatcher N, Chang A, Parikh P, Rodrigues Pereira J, Ciuleanu T, von Pawel J, Thongprasert S, Tan EH, Pemberton K, Archer V, Carroll K. Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa survival evaluation in lung Cancer). Lancet. 2005;366(9496):1527–37. https://doi.org/10.1016/S0140-6736(05)67625-8. PubMed PMID: 16257339 CrossRefPubMed

Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, Jenkins RB, Kwiatkowski DJ, Saldivar JS, Squire J, Thunnissen E, Ladanyi M. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol. 2013;8(7):823–59. https://doi.org/10.1097/JTO.0b013e318290868f. PubMed PMID: 23552377; PMCID: 4159960CrossRefPubMedPubMedCentral

Stewart EL, Tan SZ, Liu G, Tsao MS. Known and putative mechanisms of resistance to EGFR targeted therapies in NSCLC patients with EGFR mutations-a review. Translational lung cancer research. 2015;4(1):67–81. https://doi.org/10.3978/j.issn.2218-6751.2014.11.06. PubMed PMID: 25806347; PMCID: 4367712PubMedPubMedCentral

10.

Bland J, Altman D. Multiple significance tests: the Bonferroni method. BMJ. 1995;310:170.CrossRefPubMedPubMedCentral

11.

Mok TS, Wu YL, Ahn MJ, Garassino MC, Kim HR, Ramalingam SS, Shepherd FA, He Y, Akamatsu H, Theelen WS, Lee CK, Sebastian M, Templeton A, Mann H, Marotti M, Ghiorghiu S, Papadimitrakopoulou VA, Investigators A. Osimertinib or platinum-Pemetrexed in EGFR T790M-positive lung Cancer. N Engl J Med. 2017;376(7):629–40. https://doi.org/10.1056/NEJMoa1612674. PubMed PMID: 27959700CrossRefPubMed

12.

Sundaresan TK, Sequist LV, Heymach JV, Riely GJ, Janne PA, Koch WH, Sullivan JP, Fox DB, Maher R, Muzikansky A, Webb A, Tran HT, Giri U, Fleisher M, Yu HA, Wei W, Johnson BE, Barber TA, Walsh JR, Engelman JA, Stott SL, Kapur R, Maheswaran S, Toner M, Haber DA. Detection of T790M, the acquired resistance EGFR mutation, by tumor biopsy versus noninvasive blood-based analyses. Clin Cancer Res. 2016;22(5):1103–10. https://doi.org/10.1158/1078-0432.CCR-15-1031. PubMed PMID: 26446944; PMCID: 4775471CrossRefPubMed

13.

Rubin BP, Skarin AT, Pisick E, Rizk M, Salgia R. Use of cytokeratins 7 and 20 in determining the origin of metastatic carcinoma of unknown primary, with special emphasis on lung cancer. Eur J Cancer Prev. 2001;10(1):77–82. PubMed PMID: 11263595CrossRefPubMed

14.

Yang JC, Wu YL, Schuler M, Sebastian M, Popat S, Yamamoto N, Zhou C, Hu CP, O'Byrne K, Feng J, Lu S, Huang Y, Geater SL, Lee KY, Tsai CM, Gorbunova V, Hirsh V, Bennouna J, Orlov S, Mok T, Boyer M, Su WC, Lee KH, Kato T, Massey D, Shahidi M, Zazulina V, Sequist LV. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-lung 3 and LUX-lung 6): analysis of overall survival data from two randomised, phase 3 trials. The Lancet Oncology. 2015;16(2):141–51. https://doi.org/10.1016/S1470-2045(14)71173-8. PubMed PMID: 25589191 CrossRefPubMed

15.

Yang J, Ramalingam SS, Janne PA, Cantarini M, Mitsudomi T. LBA2_PR: Osimertinib (AZD9291) in pre-treated pts with T790M-positive advanced NSCLC: updated phase 1 (P1) and pooled phase 2 (P2) results. J Thorac Oncol. 2016;11(4 Suppl):S152–3. https://doi.org/10.1016/S1556-0864(16)30325-2. PubMed PMID: 27198353CrossRef

16.

Villaflor V, Won B, Nagy R, Banks K, Lanman RB, Talasaz A, Salgia R. Biopsy-free circulating tumor DNA assay identifies actionable mutations in lung cancer. Oncotarget. 2016;7(41):66880–91. https://doi.org/10.18632/oncotarget.11801. PubMed PMID: 27602770CrossRefPubMedPubMedCentral

17.

Ito K, Suzuki Y, Saiki H, Sakaguchi T, Hayashi K, Nishii Y, Watanabe F, Hataji O. Utility of liquid biopsy by improved PNA-LNA PCR clamp method for detecting EGFR mutation at initial diagnosis of non-small-cell lung Cancer: observational study of 190 consecutive cases in clinical practice. Clinical lung cancer. 2018;19(2):181–90. https://doi.org/10.1016/j.cllc.2017.10.017. PubMed PMID: 29174086CrossRefPubMed

Title: Effective osimertinib treatment in a patient with discordant T790 M mutation detection between liquid biopsy and tissue biopsy
Authors: Isa Mambetsariev
Lalit Vora
Kim Wai Yu
Ravi Salgia
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-018-4222-z

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