Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non–small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy

Alessandro Dal Maso, Martina Lorenzi, Elisa Roca, Sara Pilotto, Marianna Macerelli, Valentina Polo, Fabiana Letizia Cecere, Alessandro Del Conte, Giorgia Nardo, Vanessa Buoro, Daniela Scattolin, Sara Monteverdi, Loredana Urso, Elisabetta Zulato, Stefano Frega, Laura Bonanno, Stefano Indraccolo, Fiorella Calabrese, Pier Franco Conte, Giulia Pasello

Research output: Contribution to journalArticle


Background: Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non–small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. Patients and Methods: This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. Results: A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. Conclusion: This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
Original languageEnglish
Pages (from-to)1-14.e3
Number of pages14
JournalClin. Lung Cancer
Issue number1
Early online dateAug 5 2019
Publication statusPublished - Jan 2020



  • Acquired resistance
  • EGFR T790M mutation
  • Epidermal growth factor receptor
  • Non-small cell lung cancer
  • Tyrosine kinase inhibitors

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