Abstract 1185P
Background
Neoadjuvant targeted therapy remained controversial for mutant early-stage NSCLC. Despite limited efficacy of immunotherapy for advanced NSCLC with driver mutations, whether induction immunotherapy could be feasible for these patients warrants further exploration.
Methods
We retrospectively collected 24 NSCLC patients who harbored driver mutations including EGFR, KRAS, ALK, HER2, BRAF, RET, and received induction immunotherapy from 7 renowned centers. Radiological and pathological evaluation were measured for all patients as well as dynamic multi-omics sequencing including WES, TCR, RNA and mIHC in some patients (results pending).
Results
Of the 24 patients, 15 (62.5%) patients had a partial response, 7 (29.2%) had a stable disease and 2 (8.3%) had a progression disease after induction immunotherapy. Detailed clinical demographic data was summarized in the table. Most of the patients (21/24) received induction immunotherapy plus chemotherapy. Only one patient did not receive surgery due to newly metastatic lesions. Surgical complication was mild for most patients except for one needed blood transfusion. 12 patients had been pathologically or radiologically diagnosed with N2 metastatic lymph nodes. The pathological N2 downstaging rate was 66.7% (8/12). For patients with available pathological assessment, overall major pathological response (MPR) rate was 34.8% (8/23) and pathological complete response (pCR) rate was 17.4% (4/23). For EGFR mutations, MPR rate was 33.3% (3/9) and pCR rate was 22.2% (2/9). For KRAS mutations, MPR rate was 50.0% (3/6) and pCR rate was 16.7% (1/6). Table: 1185P
| Characteristics | All patients (N=24) | Patients with major pathological response (N=8) | Patients without major pathological response (N=15) |
| Age —— yrs | |||
| Mean ±SD | 58.1±9.2 | 57.5±8.2 | 58.5±10.2 |
| Median (range) | 60 (36-72) | 60 (47-70) | 62 (36-72) |
| Gender —— no. (%) | |||
| Female | 10 (41.7) | 2 (25.0) | 8 (53.3) |
| Male | 14 (58.3) | 7 (75.0) | 7 (46.7) |
| Smoking status —— no. (%) | |||
| Never | 11 (45.8) | 3 (37.5) | 8 (53.3) |
| Former/current | 13 (54.2) | 5 (62.5) | 7 (46.7) |
| Clinical stage —— no. (%) | |||
| IB-II | 7 (29.2) | 3 (37.5) | 3 (20.0) |
| IIIA | 12 (50.0) | 3 (37.5) | 9 (60.0) |
| IIIB-IVA | 5 (20.8) | 2 (25.0) | 3 (20.0) |
| Mutation features —— no. (%) | |||
| EGFR alteration | 9 (37.5) | 3 (37.5) | 6 (40.0) |
| KRAS alteration | 7 (29.2) | 3 (37.5) | 3 (20.0) |
| Other mutations | 8 (33.3) | 2 (25.0) | 6 (40.0) |
Conclusions
Induction immunotherapy plus chemotherapy may be potentially optional for oncogene mutant NSCLC. Further studies are warranted to clarify the response mechanism of immunotherapy and determine the most optimal treatment modalities for resectable NSCLC harboring driver mutations.
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.