Background
Molecular testing of patients with advanced non–small cell lung cancer for personalized
therapy often is limited by insufficient specimen from nonsurgical biopsies. We measured
the feasibility, patient safety, and clinical impact of thoracic surgical tumor biopsy
in patients with stage IV non–small cell lung cancer.
Methods
This is a single institution retrospective analysis. Patients with stage IV non–small
cell lung cancer undergoing elective surgical tissue biopsy for molecular analysis
were evaluated from March 2011 to November 2012. Perioperative specific variables
were measured.
Results
Twenty-five patients with known or suspected stage IV non–small cell lung cancer undergoing
surgical biopsy were identified. All cases were discussed at a multidisciplinary thoracic
oncology conference or a multidisciplinary thoracic oncology clinic. Preoperative
histologies included adenocarcinoma in 20 patients (80.0%) and squamous cell carcinoma
in 2 patients (8.0%). Surgical procedures consisted of video-assisted thoracic surgery
wedge biopsy (16, 64%), video-assisted thoracic surgery pleural biopsy (4, 16.0%),
mediastinoscopy (2, 8.0%), supraclavicular/cervical lymph node excisional biopsy (3,
12.0%), and rib/chest wall resection (2, 8.0%). There were no deaths and 5 postoperative
complications (20.0%). Surgery identified potentially targetable molecular information
in 19 of the total patients undergoing operation (76.0%) and changed the treatment
strategy in 14 patients (56.0%); 10 of the total cohort (40.0%) were enrolled into
therapeutic targeted clinical trials.
Conclusions
These data suggest that thoracic surgical biopsy can be safely performed in appropriately
selected patients with stage IV non–small cell lung cancer and direct personalized
therapy and enrollment into relevant clinical trials. Patients with advanced-stage
non–small cell lung cancer should be discussed in a multidisciplinary setting to determine
the need and strategy for thoracic surgical biopsy for molecular analysis.
CTSNet classification
Abbreviations and Acronyms:
CI (confidence interval), CT (computed tomography), EGFR (epidermal growth factor receptor), EML4-ALK (echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase), NSCLC (non–small cell lung cancer), PLOS (prolonged length of stay), RRM1 (ribonucleoside-diphosphate reductase large subunit), TKI (tyrosine kinase inhibitor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 21, 2014
Accepted:
March 11,
2014
Received in revised form:
February 16,
2014
Received:
June 28,
2013
Footnotes
Disclosures: Dr Goodwin reports equity ownership in Pronai Therapeutics and Champions Oncology. Dr Lara reports consulting fees from Pfizer, Aveo, Teva, Janssin, Medivation, Exelixis, Genentech, and Astellas. Dr Gandara reports consulting fees from Amgen, AstraZeneca, Boehringer-Ingelheim, BMS/ImClone, Celgene, GlaxoSmithKline, Genentech, Merck, Novartis, Pfizer, Sanofi-Aventis, Synta, and Response Genetics and research funding from Abbott, BMS/ImClone, Genentech,Lilly, Merck, Novartis, and Pfizer. All other authors have nothing to disclose with regard to commercial support.
Identification
Copyright
© 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
