Is bone met biopsy possible? - 1268050

Tue, 01/13/2015 - 19:52

Hello,
Thank you for this site. I have learn so much.
My dad has Adeno EGFR+, stable on Tarceva July 2013 until scan in December.
The Cat scan and f/u bone scan found bone mets rib and thoracic vertebrae.
He stopped Tarceva yesterday and starts Chemo Friday.
His oncologist mentions bone met biopsies are difficult and the DNA denatures during decalcification.
I have seen several references to bone biopsies for monitoring genetic mutations on the Grace forum. Also, I found this article from May: http://www.nature.com/bonekeyreports/2014/141001/bonekey201475/full/bon…

Is a bone biopsy feasible?
Do clinic trials not consider bone mets measurable disease to be able to monitor?
I know 3rd gen TKIs are in phase 2(?) clinical trials, but in terms of a general timeline, how close are they to completing testing?

Thank you,
Greta

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Dr West

Your oncologist gave an accurate assessment. It's possible to biopsy bone lesions, but they are not preferred for genetic testing because of all of the processing required. Some labs do it, some don't, and some clinical trials don't allow tissue samples from bone biopsies. But it is possible to get genetic testing done from biopsies of bone metastases, though not as reliably as biopsies from soft tissues.

Clinical trials do not consider bone metastases as measurable disease. Not all trials require measurable disease, and it is OK to have a combination of bone metastases and a measurable tumor in the lung or liver, etc., but things like pleural effusions and bone metastases do not lend themselves to reliable measurement as a reflection of the status of the cancer, so they are not sufficient for assessing response on clinical trials that prioritize this.

I can't give you an accurate timeline on trials. Most of the big ones are still getting off the ground, not close to nearing completion. They may enroll quickly, but I think most of the larger ones will require at least a year or two to be completed. That doesn't mean that AZD9291 and/or rociletinib won't be FDA approved before then.

Good luck.

-Dr. West

karenb

I had a biopsy on my T-5. This told my drs that the cancer had metastasized from the lung. It was a long and uncomfortable procedure and I was sore for a few days after. For the clinical trials that I was trying to get into, I had to do 2 lung biopsies. Hope this helps!

Karen