Resumen de Identifcation of non‑actionable mutations with prognostic and predictive value in patients with advanced or metastatic non‑small cell lung cancer
Mariano Provencio Pulla, Diego Pérez Parente, Sara Olson, Pedro Ruiz Gracia, Esther Vilas, Haroon Hasan, Navdeep Pal, Begoña Campos Balea, Delvys Rodríguez Abreu, Marta López-Brea, Samantha Wilkinson, Manuel Cobo Dols
Introduction Lung cancer is one of the most prevalent cancers and the leading cause of cancer death. Advanced non-small cell lung cancer (aNSCLC) patients frequently harbor mutations that impact their survival outcomes. There are limited data regarding the prognostic and predictive signifcance of these mutations on survival outcomes in the real-world setting.
Methods This observational retrospective study analyzed de-identifed electronic medical records from the Flatiron Health Clinico-Genomic and FoundationCore® databases to identify patients with aNSCLC who initiated frst-line immune checkpoint inhibitors (ICI; alone or in combination) or chemotherapy under routine care between 2016 and 2021. The primary objectives were to assess the prevalence of non-actionable mutations and to determine their association with overall survival (OS). Real-world progression-free survival (rwPFS) and real-world response (rwR) were investigated as secondary exploratory outcomes.
Results Based on an assessment of 185 non-actionable mutations in 2999 patients, the most prevalent mutations were TP53 (70%), KRAS (42%), CDKN2A/B (31%), and STK11 (21%). STK11, KEAP1, and CDKN2A/B mutations were signifcantly associated with lower rwR, shorter rwPFS and OS. KRAS mutations were clinically associated with shorter rwPFS in CITtreated patients. Subgroup analysis revealed that fast progressors were signifcantly more likely to harbor STK11, KEAP1, and CDKN2A/B mutations. Accordingly, long-term survivors (LTS) showed a signifcantly lower prevalence of these mutations.
Conclusion Our results provide evidence on the prognostic value of STK11, KEAP1, and CDKN2A/B mutations in patients with aNSCLC. Further research is required to better understand the implications of these fndings on patient management and future trial design and treatment selection.
