Department of Thoracic / Head and Neck Medical Oncology - The University of Texas MD Anderson Cancer Center, Houston, TX
Marcelo Vailati Negrao , Alexandre Reuben , Jacqulyne Ponville Robichaux , Xiuning Le , Monique B. Nilsson , Chang-jiun Wu , Jianhua Zhang , Lara C.A. Landry , Emily Roarty , Waree Rinsurongkawong , Stephen Swisher , George R. Simon , Andrew Futreal , Bonnie S. Glisson , Jianjun Zhang , John Heymach
Background: Immune checkpoint blockade has led to unprecedented durable clinical benefit in metastatic non-small cell lung cancer (NSCLC), but response rates are low for patients with targetable driver mutations. EGFR and HER-2 exon 20 mutations account for ~4% of NSCLC, but outcomes for these patients when treated with immune checkpoint blockade have not been previously reported. Methods: We queried GEMINI, a MD Anderson Lung Cancer Moon Shot funded database for prospective collection of clinical information for patients with NSCLC, for patients with driver mutations in EGFR exon 19, 20, 21 and HER-2 exon 20 and treated with immune checkpoint inhibitors. We assessed overall survival (OS), progression-free survival (PFS) and overall response rate (ORR). Results: From 2014 to 2018, 90 patients with classic EGFR mutations (exon 19 del + exon 21 L858R, n = 38), EGFR exon 20 mutations (n = 36; no T790M included) and HER-2 exon 20 mutations (n = 16) had been treated with checkpoint inhibitors. Compared to classic EGFR mutants, EGFR exon 20 mutants demonstrated a higher disease control rate at 6 and 12 months as well as higher ORR. Also, EGFR exon 20 mutants demonstrated significantly higher PFS (HR 0.45, p = 0.002) and OS (HR 0.2, p < 0.001) (Table). These differences remained significant in multivariate analysis after adjusting for age, smoking status, radiation prior to treatment initiation and treatment with concurrent agents such as chemotherapy and/or radiation. HER-2 exon 20 mutants had similar ORR and PFS compared to classic EGFR mutants (HR 1.1, p = 0.8) (Table). Conclusions: EGFR exon 20 mutations are associated with superior outcome from immune checkpoint inhibitors compared to classic EGFR and HER-2 exon 20 mutations. Further studies on PD-L1 status and tumor mutation burden in these molecularly-defined groups are ongoing to address potential underlying mechanisms associated with these findings.
EGFR exon 20 N = 36 | Classic EGFR N = 38 | HER-2 exon 20 N = 16 | |
---|---|---|---|
Disease control – N (%) | |||
6 months | 13 (36) | 6 (16) | 0 (0) |
12 months | 4 (11) | 0 (0) | 0 (0) |
Response rate – N (%) | |||
CR | 1 (3) | 0 (0) | 0 (0) |
PR | 8 (22) | 0 (0) | 1 (6) |
SD | 9 (25) | 6 (16) | 2 (13) |
PD | 15 (42) | 32 (84) | 13 (81) |
NA | 3 (8) | 0 (0) | 0 (0) |
Survival – median | |||
PFS | 2.9 | 1.9 | 1.8 |
OS | NR | 11.5 | 17.1 |
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