Somatic DNA mutations, tumor mutational burden (TMB), and MSI Status: Association with efficacy in patients (pts) with metastatic colorectal cancer (mCRC) of FIRE-3 (AIO KRK-0306).

Authors

null

Volker Heinemann

Department of Medicine III, University Hospital, LMU Munich, Munich, Germany

Volker Heinemann , Nicole Kraemer , Hannes Buchner , Ludwig Fischer von Weikersthal , Thomas Decker , Alexander Kiani , Ursula Vehling-Kaiser , Salah-Eddin Al-Batran , Tobias Heintges , Christian A. Lerchenmuller , Christoph Kahl , Frank Kullmann , Markus H. Moehler , Werner Scheithauer , Swantje Held , Dominik Paul Modest , Jens Neumann , Andreas Jung , Thomas Kirchner , Sebastian Stintzing

Organizations

Department of Medicine III, University Hospital, LMU Munich, Munich, Germany, Staburo GmbH, Munich, Germany, Department of Oncology, Gesundheitszentrum St. Marien GmbH, Amberg, Germany, Onkologie Ravensburg, Ravensburg, Germany, Klinikum Bayreuth, Bayreuth, Germany, Practice for Medical Oncology, Landshut, Germany, Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany, Medical Department II, Städtisches Klinikum Neuss Lukaskrankenhaus GmbH, Neuss, Germany, Hamatologisch Onkologische, Greven, Germany, Department for Hematology, Klinikum Magdeburg, Magdeburg, Germany, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany, University Medical Center Mainz, Mainz, Germany, Medical University of Vienna, Vienna, Austria, ClinAssess GmbH, Leverkusen, Germany, Department of Hematology and Oncology, Klinikum Grosshadern, University of Munich, Munich, Germany, Department of Pathology, University of Munich, Munich, Germany, Department of Pathology, Ludwig-Maximilians University of Munich, Munich, Germany, Ludwig Maximilian University of Munich, Munich, Germany

Research Funding

Pharmaceutical/Biotech Company

Background: FIRE-3 compared 1st-line therapy with FOLFIRI plus either cetuximab or bevacizumab in 592 KRAS exon 2 wt mCRC patients (pts). Methods: Tumor DNA was profiled by next-generation sequencing to explore molecular markers of prognosis. The biomarker evaluable subpopulation (n = 373) was representative of the ITT population. Treatment efficacy was determined in the quadruple wild-type (wt) population (RAS, BRAF, AKT, PI3K = “MAPK/mTOR wt”). Kaplan-Meier estimation and log-rank tests were employed for overall survival (OS). Hazard ratios (HR) were estimated using the Cox proportional hazard method. P-values were not adjusted for multiple testing Results: Overall frequencies were (%,n): MSI-h 2.7% (10); BRAFmut 12.1% (45); RASmut 32.7% (122); quadruple wt: 47.7% (178); TMB > 8: 15% (56). RAS, BRAF, MSI-h and quadruple-wt status were prognostic. Pts with low-frequent RAS mutations (RASmut < 5%) had a significantly longer OS when compared to pts with higher RAS mutational frequency. Conclusions: NGS analysis revealed distinct subgroups of mCRCs with different prognosis. MSI status had prognostic impact, but TMB could not be validated as a prognostic or predictive marker.

Overall survival.

NEvents N (% )Median [ 95%CI ]NEvents N (%)Median [ 95%CI ]HR [ 95%CI ], p-value
MSIMSI-H1010 ( 100)18.8 [ 2.5, 24.5 ]MSS343298 ( 87)25.4 [ 23.1, 27.6 ]1.92 [ 1.02, 3.62 ], 0.0432
TMB status 1high109 ( 90)19.8 [ 2.5, 25.2 ]intermediate114100 ( 88)25.7 [ 21.5, 29.1 ]1.28 [ 0.65, 2.54 ], 0.4725
high109 ( 90)19.8 [ 2.5, 25.2 ]low236206 ( 87)23.8 [ 21.4, 26.7 ]1.16 [ 0.60, 2.27 ], 0.6568
intermediate114100 ( 88)25.7 [ 21.5, 29.1 ]low236206 ( 87)23.8 [ 21.4, 26.7 ]0.91 [ 0.71, 1.15 ], 0.4186
TMB status 2< = 8304268 ( 88)23.8 [ 21.8, 26.1 ]> 85647 ( 84)27.5 [ 18.7, 31.1 ]1.23 [ 0.90, 1.68 ], 0.1924
BRAFwt328289 ( 88)26.4 [ 23.9, 28.8 ]Mut4539 ( 87)15.9 [ 10.9, 19.1 ]0.57 [ 0.41, 0.80 ], 0.0012
RASwt251212 ( 85)27.9 [ 24.7, 31.9 ]Mut122116 ( 95)20.6 [ 17.4, 23.6 ]0.62 [ 0.49, 0.78 ], 0.0000
MAPKwt178151 ( 85)30.8 [ 26.4, 35.2 ]mut195177 ( 91)20.8 [ 18.5 , 23.7 ]0.64 [ 0.51, 0.79 ], 0.0001

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Epidemiology/Outcomes

Citation

J Clin Oncol 36, 2018 (suppl; abstr 3591)

DOI

10.1200/JCO.2018.36.15_suppl.3591

Abstract #

3591

Poster Bd #

84

Abstract Disclosures