Impact of KRAS mutational variant on response to immunotherapy in metastatic NSCLC.

Authors

null

Shelley Kuang

Princess Margaret Cancer Centre, Toronto, ON, Canada

Shelley Kuang , Sally C. M. Lau , Kieran Sharma , Juehea Lee , Malcolm Isaiah Ryan , Sabine Schmid , Penelope Ann Bradbury , Geoffrey Liu , Frances A. Shepherd , Ming Sound Tsao , Natasha B. Leighl , Adrian G. Sacher

Organizations

Princess Margaret Cancer Centre, Toronto, ON, Canada, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada, Princess Margaret Hospital, Toronto, ON, Canada, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

Research Funding

Other Foundation
Princess Margaret Cancer Foundation (OSI Pharmaceuticals Foundation Chair)

Background: KRAS alterations constitute the most common driver mutations in metastatic non-small cell lung cancers (mNSCLC) and occur in approximately 30% of patients. KRAS mutational subtype as well as the presence of co-mutations has been associated with altered activation of downstream signaling pathways in preclinical models. We hypothesize that different KRAS G12C mutational subsets will be associated with variable clinical outcome and response to therapy. To this end, we have performed a retrospective analysis of survival and treatment outcomes by KRAS mutation subtype (G12C vs non-G12C). Methods: A review of KRAS-mutated mNSCLC patients treated with immunotherapy between 2013 and 2020 was conducted. Patient demographics, smoking status, KRAS mutational subtype, co-mutations and PD-L1 status were collected. Overall response rate (ORR) and progression-free survival (PFS) were analyzed in each subgroup. Results: 98 KRAS mutant mNSCLC patients were treated with immune checkpoint inhibitors (ICI): 37% with a KRAS G12C mutation, 62% with a non-G12C mutation. Patients with a G12C mutation were more likely to be of Caucasian ancestry (86% vs 56%; p = 0.01) whereas all other characteristics were similar between the groups including smoking history, PD-L1 expression ≥50% (61% vs 40%) and the presence of a TP53 co-mutation (48% vs. 54%); all p > 0.05. Treatment patterns were similar between the groups, with PD-1 inhibitor monotherapy given in 86% vs 79% of KRAS G12C and non-G12C patients. Overall response rate was 51% vs 27% in G12C vs non-G12C (p = 0.03). PFS was superior in G12C mutants (19.6 months vs 4.0 months), even after adjusting for smoking history, TP53 co-mutation status and PD-L1 expression (adjusted HR 0.51; p = 0.02). In subgroup analyses, the superiority in PFS was driven by the G12C mutants with high PD-L1 expression (n = 19): 26.8 months in G12C, PD-L1 high vs 4.7 months in G12C, PD-L1 low vs. 4.7 months in KRAS transversion mutations, PD-L1 high vs 4.0 months in transversion mutations, PD-L1 low vs. 3.0 months in transition mutations; p < 0.001. Conclusions: The presence of a KRAS G12C mutation is associated with improved ORR and PFS after treatment with ICI compared to non-G12C mutations in mNSCLC. The greatest benefit in PFS was observed in the subgroup with G12C mutation and high PD-L1 expression. Differential activation of downstream signaling associated with specific KRAS codon 12 mutation variants may modulate the composition of the tumor immune microenvironment thereby contributing to the variable response to immunotherapy. Further understanding on these molecular mechanisms may direct the development of new treatment strategies in KRAS mutant lung cancers.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: 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 e21127)

DOI

10.1200/JCO.2021.39.15_suppl.e21127

Abstract #

e21127

Abstract Disclosures

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