Efficacy of immune-checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC) patients harboring activating molecular alterations.

Authors

null

Laurent Mhanna

University Hospital Toulouse (Larrey), Toulouse, France

Laurent Mhanna, Julie Milia, Amellie Lusque, Sebastien Couraud, Celine Mascaux, Remi Veillon, Martin Frueh, Denis Moro-Sibilot, Mickaël Lattuca-Truc, Pascale Tomasini, Fabrice Barlesi, Alexander E. Drilon, Oliver Gautschi, Julien Mazieres

Organizations

University Hospital Toulouse (Larrey), Toulouse, France, Hôpital Larrey Centre Hospitalier Universitaire Toulouse, Toulouse, France, Institut Universitaire du Cancer de Toulouse - Oncopole, cellule biostatistique, bureau des essais cliniques, Toulouse, France, Acute Respiratory Medicine and Thoracic Oncology Department, Lyon Sud Hospital and Lyon University Cancer Institute, Pierre Benite, France, Aix Marseille University ; Assistance Publique Hôpitaux de Marseille, Marseille, France, Hopital du Haut Lévèque, Pessac, France, Cantonal Hospital St Gallen, St Gallen, Switzerland, IFCT, Chu de Grenoble, Grenoble, France, University Hospital Grenoble, Grenoble, France, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada, Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France, Memorial Sloan Kettering Cancer Center, New York, NY, Cantonal Hospital Lucerne, Luzern, Switzerland, Hôpital Larrey, Centre Hospitalier Universitaire Toulouse, Toulouse, France

Research Funding

Other

Background: Two revolutions recently occur in the treatment of advanced NSCLC: the development of targeted therapies and of ICI). Both strategies have been shown to outperform chemotherapy. Patients with molecular alterations are usually considered as poor candidate for immunotherapy. Here, we aimed to analyze the efficacy of immunotherapy in NSCLC patients with oncogenic addiction. Methods: We conducted a retrospective multicentric study, on patients treated with ICI and carrying an activating molecular abnormality: EGFR, ALK, KRAS, ROS1, HER2, BRAF, MET and RET. We have collected anonymized data, which were evaluated for clinical characteristics and outcome (progression free survival duration of ICI treatment and overall survival since initiation of ICI). Results: 209 patients were registered from 7 centers in France and Switzerland. 198 patients had adenocarcinoma (95.2%), 6 large cell carcinoma (2.9%), 161 were former or current smokers (81.3%), 99 were female (47.4%), median age at diagnosis was 59 yrs. (range 30-79). 33 patients had EGFR mutations (15.8%), 132 KRAS mutation (63.2%), 6 ALK rearrangement (2.9 %), 2 ROS1 rearrangement (1 %), 5 HER2 mutation (2.4 %), 12 BRAF mutations (5.7 %), 7 MET alteration (3.3 %), 3 RET rearrangements (1.4 %), and 9 had concomitant multiple molecular alterations (4.3%). After validated treatment 200 patients were treated with PD1 inhibitors (nivolumab, 97.5% and pembrolizumab, 2.5%), 4 with anti CTLA4 (tremelimumab), 5 with anti PDL1 (4 atezolizumab). The median PFS was 2.8 m. [95%CI 2.3;3.5] for the whole population 2.1 for EGFR [1.7;2.8], 3.5 for KRAS [2.5;4.9], 2.7 for BRAF [1.5;NR] and not estimable for other alterations. Median exposure to ICI was 1.89 m. [0;18.5]. The median overall survival for the whole population was 13.0 m. [9.4; 15.6], for EGFR 13.3 m. [4.7; NR], KRAS 11.3 m. [8.2; 16], BRAF 10.7 m. [1.5; NR] and not yet estimable for the other alterations. Conclusions: PFS (2.8 m.) and OS (13 m.) are very similar from the ones observed in pretreated unselected NSCLC patients. ICI is associated with better PFS in patients with KRAS mutation than in EGFR mutated patients. Analysis of outcome in other molecular subgroups is ongoing.

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Abstract Details

Meeting

2018 ASCO-SITC Clinical Immuno-Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Developmental Therapeutics,Genitourinary Cancer,Head and Neck Cancer,Lung Cancer,Melanoma/Skin Cancers,Gastrointestinal Cancer,Breast and Gynecologic Cancers,Combination Studies,Implications for Patients and Society,Miscellaneous Cancers,Oncolytic Viruses,Hematologic Malignancies

Sub Track

Immune Checkpoints and Stimulatory Receptors

Citation

J Clin Oncol 36, 2018 (suppl 5S; abstr 172)

DOI

10.1200/JCO.2018.36.5_suppl.172

Abstract #

172

Poster Bd #

L5

Abstract Disclosures