Therapeutic impact of mutation subtypes and concomitant STK11 mutations in KRAS–mutated non-small cell lung cancer (NSCLC): A result of nationwide genomic screening project (LC-SCRUM-Japan).

Authors

null

Yutaro Tamiya

National Cancer Center Hospital East, Kashiwa, Japan

Yutaro Tamiya , Yoshitaka Zenke , Shingo Matsumoto , Naoki Furuya , Tomohiro Sakamoto , Terufumi Kato , Kazumi Nishino , Masato Shingyoji , Shingo Miyamoto , Chigusa Shirakawa , Ryo Toyozawa , Kadoaki Ohashi , Takaya Ikeda , Kaname Nosaki , Hibiki Udagawa , Keisuke Kirita , Kiyotaka Yoh , Seiji Niho , Koichi Goto

Organizations

National Cancer Center Hospital East, Kashiwa, Japan, St. Marianna University School of Medicine, Kawasaki, Japan, Tottori University Hospital, Yonago, Japan, Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan, Osaka International Cancer Institute, Osaka, Japan, Chiba Cancer Center, Chiba, Japan, Japanese Red Cross Medical Center, Tokyo, Japan, Hyogo Kenritsu Amagasaki Byoin, Amagasaki-shi, Japan, Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan, Okayama University Hospital, Okayama, Japan

Research Funding

Other Government Agency
Japan Agency for Medical Research and Development

Background: KRAS mutations are one of the common oncogene drivers in non-small cell lung cancer (NSCLC), and the development of several targeted drugs for KRAS-mutated NSCLC is now ongoing. However, the clinical impact of KRAS mutation subtypes or concomitant other gene mutations in NSCLC patients (pts) remains unclear. Methods: In a nationwide genomic screening project (LC-SCRUM-Japan), we have prospectively analyzed lung cancer pts for genetic alterations and tumor mutation burden (TMB) by next-generation sequencing system, and for PD-L1 expression by immunohistochemistry (22C3 antibody). The therapeutic efficacy and survival of KRAS-mutated non-squamous (non-sq) NSCLC pts were evaluated using a clinico-genomic database of the LC-SCRUM-Japan. Results: A total of 5166 non-sq NSCLC pts enrolled from 2015 to 2019. KRAS mutations were detected in 794 pts (15%; G12C/G12D/G12V/G12A/G13X/others = 232/186/165/66/61/84). Among the 794 pts, TMB and PD-L1 expression were analyzed in 128 and 79, respectively, and 218 received PD-1/PD-L1 inhibitors (IO) after 1st-line chemotherapy. The median age was 66 years (range, 29-89). 142 pts (65%) were male and 172 (78%) were smokers. Concomitant STK11 mutations were detected in 33 pts (15%) with no difference in the mutation frequency among KRAS mutation subtypes. KRAS G12C was significantly associated with high TMB (≥ 10 mut/Mb) (p = 0.03), and KRAS G12C or G12V with high PD-L1 expression (≥ 50%) (p = 0.02). In pts who received IO, median progression-free survival (mPFS) was significantly longer in pts with KRAS G12C or G12V than in those with other KRAS mutations (4.7 vs 2.0 months, hazard ratio (HR) 0.58 [95%CI 0.43-0.78], p < 0.01). Among pts with KRAS G12C or G12V, mPFS of IO was significantly shorter in pts with concomitant STK11 mutations than in those without (1.8 vs. 5.7 months, HR 1.97 [95%CI 1.06-3.41], p = 0.02). These correlations were not observed in platinum-containing chemotherapy (Plt-CTx). There were also no significant differences in IO and Plt-CTx efficacies between with and without other concomitant mutations, such as TP53, RB1, CDKN2A and PTEN mutations. Conclusions: Non-sq NSCLC pts with KRAS G12C/V were more sensitive to IO therapies than those with other KRAS mutations, but KRAS G12C/V-positive pts with concomitant STK11 mutations were less sensitive than those without. These results could be highly informative in the development of novel targeted therapies for KRAS-mutated NSCLC.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Citation

J Clin Oncol 38: 2020 (suppl; abstr 9589)

DOI

10.1200/JCO.2020.38.15_suppl.9589

Abstract #

9589

Poster Bd #

355

Abstract Disclosures

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