Tumor mutational burden as a potential predictive marker for the efficacy of immunotherapy in advanced gastric cancer.

Authors

null

Jae Yeon Jang

Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;

Jae Yeon Jang , Sun Young Jeong , Seung Tae Kim

Organizations

Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;

Research Funding

No funding received
None.

Background: Tumor mutational burden (TMB) is known as an independent predictive factor in predicting treatment response of immunotherapy. We aimed to evaluate the efficacy of immunotherapy in advanced gastric cancer (AGC) according to TMB and other markers. Methods: The patients with AGC, aged ≥ 18, who received pembrolizumab or nivolumab from October 1, 2020, to July 27, 2021, at Samsung medical center in Korea, were analyzed retrospectively. TMB was measured by next-generation sequencing-based assays, and PD-L1 is tested using immunohistochemical assay 22C3 pharmDx. Referring to the results of previous studies, TMB-high was defined as 14.31 mutations/megabase (mt/Mb) or above. Results: A total of 54 AGC patients who were treated with immunotherapy, pembrolizumab or nivolumab, were analyzed. Seven patients were TMB-high, and 47 patients were TMB-low. Compared to TMB-low group, TMB-high group showed higher overall response rate (ORR) (42.9% vs 6.4%, p=0.023), and disease control rate (66.7% vs. 22.9%; p=0.033). The median OS was longer in the TMB-high group with 22.4 months (95% CI, 19.738-25.115), while the TMB-low group with 3.6 months (95% CI, 2.109-5.104; p=0.020). In addition to TMB, microsatellite status was statistically significantly associated with the efficacy of immunotherapy in AGC. Microsatellite instability group had better ORR (n=3/4, 75%) compared to microsatellite stable group (n=4/50, 8.0%; p=0.005). Other than that, the ORR of the patients whose PD-L1 CPS was 1 or above did not differ from the patients whose PD-L1 CPS was lower than 1. Although there was no statistical significance, among TMB-low patients, PD-L1 CPS ≥1 group numerically exhibited a higher overall response rate (13.0% vs 4.0%; p=0.338). Conclusions: In our analysis, the cut-off value of TMB was set to 14.31mb/Mt, and TMB-high was associated with the better ORR and OS of immunotherapy in AGC. TMB could be a potential predicting marker for a therapeutic response of immunotherapy in AGC.

Comparison of efficacy of immunotherapy in AGC patients according to TMB.
TMB < 14.31

(n = 47)
TMB 14.31

(n = 7)
p-value
Best response - No. (%)
Overall response rate6.4% (3)42.9% (3)0.023
Disease control rate22.9% (11)66.7% (4)0.044
Disease progression events28/34 (82.4%)1/5 (20.0%)0.011
Duration of treatment
(Median, months, 95% CI)
1.31 (0.830-1.780)1.38 (0.000-5.341)0.181
Progression-free survival
(Median, months, 95% CI)
2.3 (1.622-2.969)2.1 (Not calculated)0.493
Overall survival
(Median, months, 95% CI)
3.6 (2.109-5.104)22.4 (19.738-25.115)0.020
Death35/48 (72.9%)2/6 (33.3%)0.071

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cancers of the Esophagus and Stomach and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Patient-Reported Outcomes and Real-World Evidence

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 324)

DOI

10.1200/JCO.2023.41.4_suppl.324

Abstract #

324

Poster Bd #

D5

Abstract Disclosures