Molecular biology and treatment strategies for non-V600 BRAF-mutant NSCLC.

Authors

Marcelo Negrao

Marcelo Vailati Negrao

Department of Thoracic / Head and Neck Medical Oncology - The University of Texas MD Anderson Cancer Center, Houston, TX

Marcelo Vailati Negrao , Victoria M. Raymond , Richard B. Lanman , Patrick Kwok Shing Ng , Rebecca Nagy , Kimberly Banks , Viola Weijia Zhu , Bianca E Amador , Emily Roarty , Young Kwang Chae , Jeffrey Melson Clarke , Jeffrey Crawford , Sai-Hong Ignatius Ou , David R. Gandara , John Heymach , Trever Grant Bivona , Caroline Elizabeth McCoach

Organizations

Department of Thoracic / Head and Neck Medical Oncology - The University of Texas MD Anderson Cancer Center, Houston, TX, Guardant Health, Inc., Redwood City, CA, The University of Texas MD Anderson Cancer Center, Houston, TX, Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA, Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, Duke University Medical Center, Durham, NC, Duke Cancer Institute, Duke University Medical Center, Durham, NC, Chao Family Comprehensive Cancer Center, University of California, Orange, CA, University of California, Davis, Sacramento, CA, University of California San Francisco, San Francisco, CA

Research Funding

Pharmaceutical/Biotech Company
MD Anderson Lung Cancer Moonshot Program

Background: BRAF alterations (alts) account for ~4% of non-small cell lung cancers (NSCLC) with 50% being non-V600 alts. Because these alts are functionally heterogeneous and have a poorly characterized genomic landscape, determining appropriate treatment strategies is a challenge. Methods: The Guardant360 clinical database was queried for NSCLC patients (pts) with BRAF alts. Alts were categorized by clonality, type and class (1 and 2: BRAF monomer and dimer signaling; 3: requires co-occurring upstream RAS-mediated signaling). Functionality and drug screen assays were performed in Ba/F3 cells. Pts with non-V600 mutations were analyzed for sensitivity to MEK +/- BRAF inhibitors (M+Bi). Results: 306 unique BRAF alts were identified and the majority were observed once (233/306; 76%). Amplifications (806/1663; 48.5%) and missense alts (795/1663; 47.8%) were the most common occurrences. Missense alts were predominantly clonal (58%), and of known functionality (428/795; 54%). All class 1-2 alts were activating in Ba/F3 cells, while class 3 alts were found to have variable functionality (activating: 4/9). Functionality was correlated with clonality as demonstrated by class 1-3 alts having higher clonality compared to variants of unknown significance (VUS) (1: 56%; 2: 54%; 3: 45%; VUS: 38%; P<0.01). Drug screens for G469V and L597R alts showed resistance to first generation BRAF inhibitors (IC50 ≥100nM), but sensitivity to M+Bi (IC50 0.02-36nM). Growth inhibition was more pronounced for dabrafenib + trametinib (D+T) (IC50 <0.1nM) compared to encorafenib + binimetinib (IC50 8-35nM) and vemurafenib + cobimetinib (IC50 2-36nM). BRAF D594G mutation (class 3) was not activating in Ba/F3 cells. Three pts with non-V600 alts were treated with M+Bi. G469V and D594G had rapid disease progression (PFS 2 and 4 mos respectively), while pt with L597R has ongoing partial response (PFS 8+ mos). Conclusions:BRAF alts show correlation between clonality and functionality, which provides important clinical information given the numerous VUS in the BRAF non-V600 setting. Drug screens reveal non-V600 alts may be sensitive to M+Bi and suggest D+T is the most active combination. Clinical data supports that some non-V600 BRAF mutations may be sensitive to M+Bi.

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Developmental Therapeutics and Tumor Biology (Nonimmuno)

Track

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Sub Track

New Targets and New Technologies (non-IO)

Citation

J Clin Oncol 37, 2019 (suppl; abstr 3102)

DOI

10.1200/JCO.2019.37.15_suppl.3102

Abstract #

3102

Poster Bd #

94

Abstract Disclosures