Abstract 612P
Background
In the real-world setting, a subset of non-small cell lung cancer (NSCLC) patients, due to limitations in small-sample biopsies and the intrinsic heterogeneity of tumors, cannot identify genetic mutations, e.g. EGFR, ALK, KRAS, MET, BRAF, ROS1, RET, etc, before neoadjuvant treatment. In NSCLC patients with actionable mutations identified post-neoadjuvant immunochemotherapy and surgery, there's an unresolved question on selecting adjuvant treatment: EGFR-TKIs or continue immunochemotherapy.
Methods
The study included NSCLC patients with confirmed diagnoses who underwent neoadjuvant immunotherapy/immunochemotherapy, followed by surgical resection, and had postoperative NGS or qPCR-identified actionable mutations.
Results
The study included 44 patients, with EGFR being the most common (30.8%, n=14), followed by KRAS (29.5%, n=13), ALK (11.4%, n=5), and less frequently ROS1, RET, HER-2, BRAF, PIK3CA, and MET. Among the participants, 56.8% of patients received adjuvant immunochemotherapy, while 25.0% of patients were treated with targeted therapy. Hazard ratio (HR) for adjuvant targeted therapy versus immunochemotherapy for DFS was 0.215, p=0.054. In the EGFR mutation subgroup, the HR for DFS was 0.129 (p=0.065). In patients with N2-N3 involvement, the HR was 0.220 (p=0.055); and for those not achieving a major pathological response, the HR was 0.331 (p=0.104). Notably, in the ypNx subgroup, an HR of 0.089 (p=0.027) was observed, indicating a substantial benefit of targeted therapy in this particular cohort.
Conclusions
This research sheds light on adjuvant targeted therapy over adjuvant ICI-based regimen in NSCLC with actionable driver mutations accidently detected after neoadjuvant immunochemotherapy and surgery.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.