AntiPD1/antiPDL1-based immunotherapy has changed dramatically the prognosis of NSCLC p with a substantial improvement of overall survival (OS) and even presenting long lasting responses in a subset of p. Several factors have been associated with the likelihood of better survival, which include the smoking exposure and the presence of KRAS-mut according to data from randomized clinical trials that compared chemotherapy to these immunotherapeutic agents.
By reviewing the clinical records of all stage IV NSCLC p treated with antiPD1/antiPDL1 agents, we identified p with KRAS-mut and evaluated their clinical outocomes.
129 p with advanced NSCLC were treated with nivolumab, pembrolizumab or atezolizumab (65.1%, 17.1% and 17.8%, respectively) from November 2013 to April 2017. 14 p were identified as adenocarcinomas with KRAS-mut (20.3%) of all non-squamous NSCLC (60p) once squamous cell carcinoma (39 p), p with Kras status unknown (15p), or due to other reasons (6p) were excluded. Kras-mut subgroup included 28.5% of female, with median age of 62.3 years, 92.8% of ever smokers, and PS0 and 1 in 21.4 and 78.6%, respectively. The immunotherapy consisted of nivolumab (71.4%) and pembrolizumab and atezolizumab (14.3% each) and was administered as 1st, 2nd and ≥3rd therapy in 7.1, 78.6 and 14.3% of p, respectively. 71.4% of p responded to therapy (64.3% were evaluated as partial response) and in 42.8% of p this response lasted ≥12 months (range 12-32). For this cohort of p median progression-free survival was 7.65 months and median OS was 58 months. At the time of analysis 57.1% were still receiving treatment.
Although the number of p is small, KRAS-mut p represent a subgroup of p that seem to substantially benefit from antiPD1/PDL1 agents in terms of both response and survival.
Clinical trial identification
Legal entity responsible for the study
Medical Oncologya Department, Catalan Institute of Oncology Badalona
All authors have declared no conflicts of interest.