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Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2019 ASCO Annual Meeting but not presented at the Meeting, can be found online only.

Rebiopsy in patients with or without prior TKIs revealed complicated histology of lung cancer.

Metastatic Non-Small Cell Lung Cancer

Lung Cancer—Non-Small Cell Metastatic

2019 ASCO Annual Meeting

Abstract No:

J Clin Oncol 37, 2019 (suppl; abstr e20525)

Author(s): Kuikui Zhu, Qianwen Li, Sheng Zhang, Gang Wu, Qun Xiang, Zhili Fang, Rui Meng; Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Union Hospital Tongji Medical College Huazhong Universtiy of Science and Technology, Wuhan, China; The Medical Department, 3D Medicines Inc., Shanghai, China

Abstract Disclosures


Background: The important of rebiopsy is well known in lung adenocarcinomas (ADs) after acquiring resistant to TKIs, for they may transform to SCLC. But histology transformation in non-ADs or ADs without TKIs seems infrequent. Methods: We performed a retrospective collection of cases with changed histology after rebiopsy in patients presenting from January 2015 to April 2018 in a single center. Results: Among 188 patients who conducted rebiopsy, there were 20 cases presenting changed histologic type, which can be divided into two groups based on if TKIs were used before histology change. Group1 (TKIs used, N = 14) including ADs changing to SCLC (N = 9), squamous cell carcinoma (SQ) (N = 2), carcinosarcoma combined with few AD component (N = 1), SCLC combined AD (N = 1), and adenosquamous carcinoma changing to SCLC (N = 1). Four cases in group 1 went through surgery, and one of them who never smoke was diagnosed as AD (pT2N0M1a, EGFR exon 19del), with no small cell carcinoma (SCC) component found, but rebiopsy of metastasis revealed SCC without any AD component after 3 months of gefitinib. The disease continued to progress during the following chemotherapy (CT), and biopsies with other two metastases also presented SCC without AD component. Group 2 were 6 cases without TKIs before the rebiopsy (Table). Case 2, 4, 6 were all heavy smokers. Rebiopsy of case 2 was ALK+, so the patient took 4 months crizotinib and then 2 months alectinib, the disease was still stable on January 6, 2019. Case 5 was a classic extensive-stage SCLC with fast response to EP therapy, but fast relapse and resistance to the following CT, and the primary lesion at right upper lobe showed AD-like imaging, so rebiopsy was performed and carcinoma favor AD was found. EGFR exon 19del was detected in the plasma, and the lesion gain PR after one month of icotinib. The third biopsy of the progress lesion came back to SCC after resistance to TKI. Conclusions: Rebiopsy of lung cancers with or without TKIs therapy revealed diversity histology changes. This reminded us the important of rebiopsy, not only for TKIs resistant lung ADs.

CaseSex/Age(y)SmokingStage (primary)Primary histologyTreatment (before histology change)Second histologyTime of histology change (mo)
2M/62YT1N1M1 (IVB)ADCT, RTneuroendocrine carcinoma (NEC), favor atypical carcinoid21
5F/55NT2N1M1 (IVB)SCCCT, RTcarcinoma favor AD13
6M/76YT2aN0M0 (IB)SQSurgeryNSCC favor AD, with NEC differentiation22

Other Abstracts in this Sub-Category:


1. Association of STK11/LKB1 genomic alterations with lack of benefit from the addition of pembrolizumab to platinum doublet chemotherapy in non-squamous non-small cell lung cancer.

Meeting: 2019 ASCO Annual Meeting Abstract No: 102 First Author: Ferdinandos Skoulidis
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Meeting: 2019 ASCO Annual Meeting Abstract No: 9000 First Author: Kazuhiko Nakagawa
Category: Lung Cancer—Non-Small Cell Metastatic - Metastatic Non-Small Cell Lung Cancer