Abstract 688P
Background
Approximately 30% Caucasian NSCLC patients carry KRAS mutations. First-line chemotherapy combined with immunotherapy has been the standard therapeutic regimen for KRAS-mutant NSCLC patients. This population could also benefit from chemotherapy combined with anti-angiogenic therapy. However, few studies has reported on head-to-head efficacy comparisons between these two treatment strategies.
Methods
We selected patients with stage IV KRAS-mutated lung adenocarcinoma diagnosed in 2017 to 2022. Their clinical baseline characteristics, first-line treatment strategy, whether combined TP53 or STK11 mutation, PD-L1 expression level, etc. were evaluated. The correlation between these factors and progression-free survival (PFS) and overall survival (OS) were analyzed.
Results
From 1548 registered patients with lung cancer, 295 were selected with a KRAS mutation and 273 received first-line systematic therapy. Of the 273 patients, the most common KRAS mutation was KRAS G12C (34.3%). First-line chemotherapy combined with immunotherapy brought significant survival benefits (mPFS: 11.0 months vs. 4.0 months, P=0.0003; mOS: 17.0 months vs. 9.0 months, P=0.0002) compared with first-line chemotherapy combined with anti-angiogenic therapy. Among the 203 patients who received first-line chemotherapy combined with immunotherapy, PD-L1 positive NSCLC patients responded better than PD-L1 negative patients (mPFS: 11.0 months vs. 4.0 months, P=0.0004; mOS: 21.0 months vs. 11.0 months, P=0.0005). MPFS was significantly prolonged in NSCLC patients who carry KRAS G12C mutation (mPFS: 16.0 months vs. 9.0 months, P=0.040; mOS: 33.0 months vs. 16.0 months, P=0.062).
Conclusions
Compared with first-line chemotherapy combined with anti-angiogenic therapy, first-line chemotherapy combined with immunotherapy has brought significant survival benefit to advanced KRAS mutant NSCLC patients, especially for PD-L1 positive patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
National Natural Science Foundation of China.
Disclosure
All authors have declared no conflicts of interest.