Characterization of KRAS mutations (mt) in non-small cell lung cancer (NSCLC).

Authors

Stephen V. Liu

Stephen V. Liu

Georgetown University, Washington, DC

Stephen V. Liu , Ari M. Vanderwalde , Hirva Mamdani , Luis E. Raez , Yasmine Baca , Joanne Xiu , Wolfgang Michael Korn , Misako Nagasaka , Sachin Gopalkrishna Pai , Mark A. Socinski , Jorge J. Nieva , Chul Kim , Antoinette J. Wozniak , Chukwuemeka Ikpeazu Sr., Gilberto Lopes , Alexander I. Spira , Julia Judd , Edward S. Kim , Hossein Borghaei

Organizations

Georgetown University, Washington, DC, The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN, Barbara Ann Karmanos Cancer Institute, Detroit, MI, Memorial Cancer Institute, Florida International University, Miami, FL, Caris Life Sciences, Phoenix, AZ, University of California San Francisco, San Francisco, CA, University of South Alabama, Mobile, AL, AdventHealth Cancer Institute, Orlando, FL, University of Southern California, Los Angeles, CA, Room 417 (pod B, second floor), Washington, DC, Hillman Cancer Center University of Pittsburgh, Pittsburgh, PA, University of Miami Sylvester Comprehensive Cancer Center, Plantation, FL, University of Miami Health System, Miami, FL, Virginia Cancer Specialists, Fairfax, VA, Temple University Health System, Philadelphia, PA, Levine Cancer Institute/Atrium Health, Charlotte, NC, Fox Chase Cancer Center, Philadelphia, PA

Research Funding

No funding received
None

Background: KRAS is the most commonly mutated oncogene in NSCLC and the development of direct KRAS inhibitors has renewed interest in this molecular subtype. However, there are several different KRAS mts, representing unique biology and different prognostic and therapeutic impact. A more comprehensive understanding of the genomic landscape relative to each KRAS mt subset will help guide therapeutic development. Methods: Molecular profiles of 17,113 NSCLC specimens were obtained using next-generation sequencing of 592 genes (Caris Life Sciences) and classified based on presence and types of KRAS mt. Incidence of KRAS mts was noted across the cohort and by histology. Co-occurring genomic alterations, tumor mutational burden (TMB) and PD-L1 IHC (22C3, TPS score) were analyzed by KRAS mt type. Results: Across the entire cohort, 4706 (27%) of samples harbored a KRAS mt (Table). The most common was G12C (40%), followed by G12V (19%) and G12D (15%). The prevalence of KRAS mt was 37.2% among adenocarcinoma and only 4.4% in squamous. High TMB, defined by > 10 mts/Mb, varied across the different KRAS mt types, most common in G13X (68.3%) and least common in G12D (43.2%). PD-L1 expression also varied. G12C was the most likely to be PD-L1 positive, with 65.5% TPS > 1%, and the most likely to be PD-L1 high, with 41.3% TPS > 50%. STK11 was mutated in 8.6% of KRAS wild type NSCLC but more frequently noted in every KRAS subtype, with the highest rate in G13X (36.2%) and the lowest in G12D(14.2%). TP53 mts were more frequent in KRAS wild type NSCLC (73.6%), with the highest rate among KRAS mutants at 55.4% (G12other) and the lowest at 36.8% (Q61X). NF1 was noted to be mutated in 21.4% of KRAS G13X cases, while all other KRAS mts had a lower frequency of NF1 mts than KRAS wild type (11.5%). Conclusions: KRAS mts are relatively common in lung adenocarcinoma and KRAS G12C is the most common variant. The different KRAS mts have different co-occurring mutations and a different genomic landscape. KRAS G12C was associated with the highest rate of PD-L1 expression. The clinical relevance of these differences in the context of therapeutic intervention warrants investigation.

KRAS WTKRAS G12CKRAS G12VKRAS G12DKRAS G13XKRAS Q61XKRAS G12AKRAS G12other
Incidence124071882915684327313298210
TMB > 10 mut/Mb50.1%58.1%55.3%43.2%68.3%51.2%52.3%65.0%
PDL1 > 1%52.1%65.5%58.2%62.7%57.7%62.6%61.5%56.4%
PDL1 > 50%25.9%41.3%35.2%35.3%35.0%36.7%36.3%28.2%
STK11 mutant8.6%23.0%23.6%14.2%36.2%26.2%23.4%29.2%
KEAP1 mutant4.2%6.3%5.7%3.7%13.1%5.1%6.0%5.7%
TP53 mutant73.6%48.9%46.0%44.0%52.8%36.8%43.1%55.4%

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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

Biologic Correlates

Citation

J Clin Oncol 38: 2020 (suppl; abstr 9544)

DOI

10.1200/JCO.2020.38.15_suppl.9544

Abstract #

9544

Poster Bd #

310

Abstract Disclosures

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