Meeting
2021 ASCO Annual Meeting
The role of chemotherapy plus immune checkpoint inhibitors in oncogenic driven non-small cell lung cancer: A University of California Lung Cancer Consortium retrospective study.
Authors
Karen Kelly
University of California Davis Comprehensive Cancer Center, Sacramento, CA
Karen Kelly , Shuai Chen , Joanna B Eldredge , David Joseph Benjamin , Matthew C Mulroy , Nadeem Tabbara , John Sharp , Jonathan Wade Goldman , Matthew A. Gubens , Jeremy P. Harris , Megan Eileen Daly , Sandip Pravin Patel , Jason Chan , Amy Lauren Cummings , Viola Weijia Zhu
Organizations
University of California Davis Comprehensive Cancer Center, Sacramento, CA, University of California Davis, Davis, CA, University of California, Davis, Sacramento, CA, UC Irvine Healthcare, Orange, CA, UCLA Medical Center, Los Angeles, CA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, UCLA Health, Los Angeles, CA, University of California, Los Angeles, CA, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, University California Irvine, Irvine, CA, Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, University of California, San Diego, San Diego, CA, University of California San Francisco, San Francisco, CA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
Research Funding
No funding received
None
Background: Immune checkpoint inhibitors (ICIs) have demonstrated limited efficacy in patients (pts) with actionable oncogenic drivers. As a result, pts with the prototypic oncogenic drivers (EGFR and ALK) have purposefully been excluded from many NSCLC ICI trials although ICI is commonly used in combination with chemotherapy for these pts. Data from one randomized trial that included pts with known EGFR and ALK alterations did not show a survival benefit with an ICI plus a platinum doublet. We sought to gain further insight into the role of chemotherapy plus ICI in pts with oncogenic driven tumors. Methods: We conducted a retrospective analysis of pts with oncogenic drivers (EGFR, ALK, ROS1, BRAF, MET, RET, HER2 and KRAS) who were treated with chemotherapy (C) or chemotherapy plus ICI (C+ICI) between 2018 and 2019 at the five University of California (UC) NCI Designated Cancer Centers (UC Irvine, UC Davis, UC Los Angeles, UC San Diego and UC San Francisco). Descriptive statistics were used. Kaplan-Meier plots and confidence intervals summarize PFS and OS in the overall cohort and oncogenic subgroups. Results: 125 pts were identified. Median age 64.1 years; M/F (45%/55%); White/Asian (59%/33%); Current/Former/Never Smokers (4%/39%/57%); PS 0/1/2(22%/68%/10%); prior number of tyrosine kinase inhibitors 0/1/2/ > 3 (46%/23%/19%/11%); Oncogenic driver: EGFR mutations (60%), KRAS mutations (23%), ALK fusions (8%), MET mutations (2.4%), RET fusions (1.6%), ROS1 fusions (1.6%), HER2 mutations (1.6%), and BRAF mutations (0.8%). The table below displays the efficacy outcomes. Conclusions: There was no survival benefit for pts with oncogenic drivers treated with chemotherapy plus an immune checkpoint inhibitor in the overall cohort or any of the subsets. Pts with KRAS mutations treated with C+ICI had a numerically longer median PFS than their counterparts treated with C. Updated data and additional analyses including PD-L1, TMB, co-mutations and toxicity will be presented.
| Cohort | # of Pts (C/C+ICI) | PFS (HR) | Median PFS (C/C+ICI) | OS (HR) | Median OS (C/C+ICI) |
|---|---|---|---|---|---|
| All patients | 70/55 | 1.07 (0.72, 1.59) P = 0.72574 | 225 days/219 days | 0.80 (0.48, 1.33) P = 0.38655 | 555 days/653 days |
| EGFR | 50/25 | 1.13 (0.67, 1.91) P = 0.64177 | 213 days/178 days | 0.77 (0.40, 1.49) P = 0.44319 | 496 days/574 days |
| KRAS | 8/22 | 0.85 (0.33, 2.19) P = 0.73898 | 176 days/249 days | 0.82 (0.21, 3.21) P = 0.77742 | NR/NR |
| Non-EGFR/KRAS | 12/8 | 1.37 (0.50, 3.71) P = 0.53906 | 285 days/200 days | 1.34 (0.35, 5.13) P = 0.66511 | 944 days/653 days |
| Never smoker | 41/30 | 1.14 (0.68, 1.90) P = 0.62813) | 246 days/232 days | 0.77 (0.40, 1.48) P = 0.43269 | 555 days/599 days |
| Current/Former smoker | 29/25 | 1.00 (0.54, 1.85) p = 0.99526 | 206 days/214 days | 0.83 (0.36, 1.92) P = 0.66541 | 546 days/NR |
PFS – Progression Free Survival; HR – Hazard Ratio; OS – Overall Survival; NR – Not Reached.
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Abstract Details
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 39, 2021 (suppl 15; abstr 9059)
DOI
10.1200/JCO.2021.39.15_suppl.9059
Abstract #
9059
Poster Bd #
Online Only
Abstract Disclosures
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