Abstract 203P
Background
Current evidence suggests that patients with unresectable non-small cell lung cancer (NSCLC) whose tumours habour driver mutations do not benefit from immune checkpoint inhibition. KRAS mutations (KRASmt), however, seem to be the exceptions to the rule. To this end, we compared KRASmt patients who were treated with immunotherapy to those without in terms of clinical outcome.
Methods
ALLSTAR is a nationwide registry for patients with histologically verified non-operable NSCLC aged 18 or older having a curative treatment option. This report presents a sub-cohort of KRASmt patients who were recruited between 2020/03 and 2023/04. The diagnostic work-up included 18F-FDG-PET-CT scan and contrast enhanced cranial CT or – preferably – MRI. Patients were treated with chemoradiotherapy (CRT) either followed by immune checkpoint inhibition (ICI) or not.
Results
Thirty-two KRASmt patients with a median follow-up of 25.9 months were included in this analysis. After chemoradiotherapy (CRT), 27/32 (84%) patients received ICI. The 2-years overall survival rate in KRASmt patients who received immunotherapy was significantly better compared to those without ICI (N=32; 84% versus 20%; p < 0.001). Likewise, the 2-years progression-free-survival with immunotherapy was also significantly better than in those without ICI (N=32; 75% versus 20%; p < 0.001). Of the 12/32 patients (38%) who had received radiation doses >66 Gy, none had a locoregional relapse, whereas in the other 20 patients, 5 (25%) events occurred (p-value=0.116).
Conclusions
Since KRASmt patients benefit from ICI treatment, immunotherapy should be offered to these patients similar to those without actionable genetic drivers. Additionally, radiation dose escalation >66 Gy may improve locoregional control also in this subset of patients.
Legal entity responsible for the study
The authors.
Funding
AstraZeneca.
Disclosure
All authors have declared no conflicts of interest.