Not all treated KRAS-mutant pancreatic adenocarcinomas are equal: KRAS G12D and survival outcome.

Authors

null

Bach Ardalan

Sylvester Comprehensive Cancer Center, Miami, FL

Bach Ardalan , Aaron Ciner , Yasmine Baca , Sourat Darabi , Anup Kasi , Emil Lou , Jose Ignacio Azqueta , Joanne Xiu , Chadi Nabhan , Anthony F. Shields , Andrew Aguirre , Harshabad Singh , Rachna T. Shroff , Michael J. Pishvaian , Sanjay Goel

Organizations

Sylvester Comprehensive Cancer Center, Miami, FL, University of Maryland, Baltimore, MD, Caris Life Sciences, Phoenix, AZ, Hoag Memor Hosp, Newport Beach, CA, University of Kansas Cancer Center, Westwood, KS, University of Minnesota, Minneapolis, MN, University of Miami Sylvester Cancer Center, Miami, FL, Barbara Ann Karmanos Cancer Institute, Detroit, MI, Dana-Farber Cancer Institute, Boston, MA, Dana-Farber Cancer Institute, Brookline, MA, University of Arizona Cancer Center, Tucson, AZ, Johns Hopkins University School of Medicine, Washington, DC, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

Research Funding

No funding received
None.

Background: KRAS is an oncogenic driver in pancreatic ductal adenocarcinoma (PDAC) with mutations identified in > 90% of cases. G12D is the most frequent variant, followed by G12V and G12R. We recently reported on the prognostic impact of distinct KRAS mutations. The current study utilized a large clinical and genomic database, to further explore and characterize the prognostic and molecular differences between KRAS variants, focusing on KRAS G12D and G12R. Methods: PDAC samples were tested using whole transcriptome sequencing (WTS; Illumina NovaSeq) and NextGen DNA sequencing (NextSeq, 592 Genes and NovaSEQ, WES) at Caris Life Sciences (Phoenix, AZ). Transcriptomic signatures including MPAS (MAPK activation score), T-cell inflamed score and tumor micro environment (TME) characterization were calculated on WTS data. Significance was determined by X2 and Fisher-Exact and p-value was adjusted for multiple comparisons (q). Real-world overall survival (rwOS) obtained from insurance claims data was calculated from tissue collection to last contact (comparison done by Kaplan-Meier test). Results: 5,555 PDAC patients harboring either KRAS G12D (n = 2,671), G12V (n=1,871) G12R (n = 904) or G12C (n = 109) variants were identified. Patients with KRAS G12R mutant tumors had significantly longer OS compared to G12D (396 vs 311 days, HR 0.81, CI 0.74-0.88, p<0.0001). There was no difference among KRAS variants in the rate of TP53, CDKN2A and SMAD4 mutations. ARID1A and KMT2D were more frequently mutated in KRAS G12D vs. G12R. The MPAS gene signature reflecting MAPK pathway activation trended lower in G12R vs. G12D. Expression of multiple genes in this pathway was statistically lower in the G12R cohort. Immune profiling suggested that: PDL1 expression is significantly lower in G12R vs G12D (13% vs 19%), TMB-H and dMMR were comparable in G12D vs G12R and several glucose and glutamine metabolism genes were significantly lower in expression when comparing G12R vs G12D - table. OS was improved within the G12R cohort for those patients on metformin (n=273 patients) (416 vs 388 days, HR 0.84, CI 0.72-0.99, p =0.037) while no difference was seen in those with KRAS G12D based on metformin use. Conclusions: Patients with G12D mutations have significantly lower survival compared to G12R. Significant molecular differences were seen in MAPK pathway gene expression, markers of immune activation, and genes involved in glucose and glutamine metabolism. Intriguingly, metformin use appeared to impact survival in the KRAS G12R subgroup. We aim to further explore distinct vulnerabilities based on MAPK pathway activation and dysregulated metabolism. Based on this data, future studies should address the KRAS mutation status and explore distinct therapeutic vulnerabilities.

AssociationGeneFC (G12R/G12D)q value
Glutamine metabolismGOT10.880.025
GOT20.86<0.001
Glucose metabolismSLC2A10.82<0.001
LDHA0.860.001
RPE0.890.032

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer - Advanced/Metastatic Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 4020)

DOI

10.1200/JCO.2023.41.16_suppl.4020

Abstract #

4020

Poster Bd #

341

Abstract Disclosures

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