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
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.
N | Events N (% ) | Median [ 95%CI ] | N | Events N (%) | Median [ 95%CI ] | HR [ 95%CI ], p-value | |||
---|---|---|---|---|---|---|---|---|---|
MSI | MSI-H | 10 | 10 ( 100) | 18.8 [ 2.5, 24.5 ] | MSS | 343 | 298 ( 87) | 25.4 [ 23.1, 27.6 ] | 1.92 [ 1.02, 3.62 ], 0.0432 |
TMB status 1 | high | 10 | 9 ( 90) | 19.8 [ 2.5, 25.2 ] | intermediate | 114 | 100 ( 88) | 25.7 [ 21.5, 29.1 ] | 1.28 [ 0.65, 2.54 ], 0.4725 |
high | 10 | 9 ( 90) | 19.8 [ 2.5, 25.2 ] | low | 236 | 206 ( 87) | 23.8 [ 21.4, 26.7 ] | 1.16 [ 0.60, 2.27 ], 0.6568 | |
intermediate | 114 | 100 ( 88) | 25.7 [ 21.5, 29.1 ] | low | 236 | 206 ( 87) | 23.8 [ 21.4, 26.7 ] | 0.91 [ 0.71, 1.15 ], 0.4186 | |
TMB status 2 | < = 8 | 304 | 268 ( 88) | 23.8 [ 21.8, 26.1 ] | > 8 | 56 | 47 ( 84) | 27.5 [ 18.7, 31.1 ] | 1.23 [ 0.90, 1.68 ], 0.1924 |
BRAF | wt | 328 | 289 ( 88) | 26.4 [ 23.9, 28.8 ] | Mut | 45 | 39 ( 87) | 15.9 [ 10.9, 19.1 ] | 0.57 [ 0.41, 0.80 ], 0.0012 |
RAS | wt | 251 | 212 ( 85) | 27.9 [ 24.7, 31.9 ] | Mut | 122 | 116 ( 95) | 20.6 [ 17.4, 23.6 ] | 0.62 [ 0.49, 0.78 ], 0.0000 |
MAPK | wt | 178 | 151 ( 85) | 30.8 [ 26.4, 35.2 ] | mut | 195 | 177 ( 91) | 20.8 [ 18.5 , 23.7 ] | 0.64 [ 0.51, 0.79 ], 0.0001 |
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Abstract Disclosures
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