2022 World Conference on Lung Cancer (ePosters)-EP08.02-035. Clinical Utility of Liquid Biopsy After Progression to First and Second-Generation TKIs in Advanced EGFR Mutant NSCLC Patients

EP08.02-035. Clinical Utility of Liquid Biopsy After Progression to First and Second-Generation TKIs in Advanced EGFR Mutant NSCLC Patients

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Liquid biopsy (LB) has become increasingly valuable in guiding targeted therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC). It has both prognostic and predictive implications for patients with EGFR mutations. The detection of key oncogenic alterations through LB has been associated with worse outcomes and a higher disease burden.<br /><br />A study analyzed 295 LB samples, of which 122 (41.4%) had a positive T790M mutation as a secondary resistance mechanism. Of these positive cases, 19.6% had T790M alone, 56.5% had T790M along with exon19del, 22.1% had T790M with L858R, and 1.6% had T790M with exon19delL858R.<br /><br />In some cases, subsequent LBs were conducted due to an initial negative result. In 3.1% of these cases, a positive T790M mutation was detected. Among patients with a T790M mutation, 28.2% received osimertinib, with 64.9% in a second-line setting and 35.1% in third-line or later therapy.<br /><br />The median overall survival (OS) was 45 months for patients with a negative LB and 25 months for those with a positive LB. There was no difference in OS based on the type of EGFR mutation detected on LB. However, regardless of the line of therapy, patients who received osimertinib had a significantly better OS compared to those who did not.<br /><br />Clinical characteristics associated with a positive LB at disease progression included extrathoracic involvement, metastasis to three sites, and the presence of bone metastases.<br /><br />This study confirms the prognostic and predictive value of LB in a real-world context. A positive LB at disease progression is linked to poorer survival and a greater disease burden. Osimertinib has shown to improve overall survival in advanced EGFR-mutant NSCLC, particularly after previous treatment with EGFR-TKIs.

Asset Subtitle

David Heredia

Meta Tag

Speaker David Heredia

Topic Metastatic Non-small Cell Lung Cancer - Molecular Targeted Treatments

Keywords

Liquid biopsy

EGFR-mutant non-small cell lung cancer

targeted therapy

prognostic implications

predictive implications

oncogenic alterations

T790M mutation

osimertinib

overall survival

disease burden