TY - JOUR
T1 - Oncogene-specific differences in tumor mutational burden, PD-L1 expression, and outcomes from immunotherapy in non-small cell lung cancer
AU - Negrao, Marcelo V.
AU - Skoulidis, Ferdinandos
AU - Montesion, Meagan
AU - Schulze, Katja
AU - Bara, Ilze
AU - Shen, Vincent
AU - Xu, Hao
AU - Hu, Sylvia
AU - Sui, Dawen
AU - Elamin, Yasir Y.
AU - Le, Xiuning
AU - Goldberg, Michael E.
AU - Murugesan, Karthikeyan
AU - Wu, Chang Jiun
AU - Zhang, Jianhua
AU - Barreto, David S.
AU - Robichaux, Jacqulyne P.
AU - Reuben, Alexandre
AU - Cascone, Tina
AU - Gay, Carl M.
AU - Mitchell, Kyle G.
AU - Hong, Lingzhi
AU - Rinsurongkawong, Waree
AU - Roth, Jack A.
AU - Swisher, Stephen G.
AU - Lee, Jack
AU - Tsao, Anne
AU - Papadimitrakopoulou, Vassiliki
AU - Gibbons, Don L.
AU - Glisson, Bonnie S.
AU - Singal, Gaurav
AU - Miller, Vincent A.
AU - Alexander, Brian
AU - Frampton, Garrett
AU - Albacker, Lee A.
AU - Shames, David
AU - Zhang, Jianjun
AU - Heymach, John V.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/8/10
Y1 - 2021/8/10
N2 - Non-small cell lung cancer (NSCLC) patients bearing targetable oncogene alterations typically derive limited benefit from immune checkpoint blockade (ICB), which has been attributed to low tumor mutation burden (TMB) and/or PD-L1 levels. We investigated oncogene-specific differences in these markers and clinical outcome. Three cohorts of NSCLC patients with oncogene alterations (n=4189 total) were analyzed. Two clinical cohorts of advanced NSCLC patients treated with ICB monotherapy [MD Anderson (MDACC; n=172) and Flatiron Health-Foundation Medicine Clinico-Genomic Database (CGDB; n=894 patients)] were analyzed for clinical outcome. The FMI biomarker cohort (n=4017) was used to assess the association of oncogene alterations with TMB and PD-L1 expression. High PD-L1 expression (PD-L1 ≥50%) rate was 19%–20% in classicEGFR,EGFRexon 20 andHER2-mutant tumors, and 34%–55% in tumors withALK,BRAFV600E,ROS1,RET, orMETalterations. Compared withKRAS-mutant tumors,BRAFnon-V600E group had higher TMB (9.6 vsKRAS7.8 mutations/Mb, p=0.003), while all other oncogene groups had lower TMB (p<0.001). In the two clinical cohorts treated with ICB, molecular groups withEGFR,HER2,ALK,ROS1,RET, orMETalterations had short progression-free survival (PFS; 1.8–3.7 months), whileBRAFV600E group was associated with greater clinical benefit from ICB (CGDB cohort: PFS 9.8 months vsKRAS3.7 months, HR 0.66, p=0.099; MDACC cohort: response rate 62% vsKRAS24%; PFS 7.4 vsKRAS2.8 months, HR 0.36, p=0.026).KRASG12C and non-G12C subgroups had similar clinical benefit from ICB in both cohorts. In a multivariable analysis,BRAFV600E mutation (HR 0.58, p=0.041), PD-L1 expression (HR 0.57, p=0.022), and high TMB (HR 0.66, p<0.001) were associated with longer PFS. High TMB and PD-L1 expression are predictive for benefit from ICB treatment in oncogene-driven NSCLCs. NSCLC harboringBRAFmutations demonstrated superior benefit from ICB that may be attributed to higher TMB and higher PD-L1 expression in these tumors. MeanwhileEGFRandHER2mutations andALK,ROS1,RET, andMETfusions define NSCLC subsets with minimal benefit from ICB despite high PD-L1 expression in NSCLC harboring oncogene fusions. These findings indicate a TMB/PD-L1-independent impact on sensitivity to ICB for certain oncogene alterations.
AB - Non-small cell lung cancer (NSCLC) patients bearing targetable oncogene alterations typically derive limited benefit from immune checkpoint blockade (ICB), which has been attributed to low tumor mutation burden (TMB) and/or PD-L1 levels. We investigated oncogene-specific differences in these markers and clinical outcome. Three cohorts of NSCLC patients with oncogene alterations (n=4189 total) were analyzed. Two clinical cohorts of advanced NSCLC patients treated with ICB monotherapy [MD Anderson (MDACC; n=172) and Flatiron Health-Foundation Medicine Clinico-Genomic Database (CGDB; n=894 patients)] were analyzed for clinical outcome. The FMI biomarker cohort (n=4017) was used to assess the association of oncogene alterations with TMB and PD-L1 expression. High PD-L1 expression (PD-L1 ≥50%) rate was 19%–20% in classicEGFR,EGFRexon 20 andHER2-mutant tumors, and 34%–55% in tumors withALK,BRAFV600E,ROS1,RET, orMETalterations. Compared withKRAS-mutant tumors,BRAFnon-V600E group had higher TMB (9.6 vsKRAS7.8 mutations/Mb, p=0.003), while all other oncogene groups had lower TMB (p<0.001). In the two clinical cohorts treated with ICB, molecular groups withEGFR,HER2,ALK,ROS1,RET, orMETalterations had short progression-free survival (PFS; 1.8–3.7 months), whileBRAFV600E group was associated with greater clinical benefit from ICB (CGDB cohort: PFS 9.8 months vsKRAS3.7 months, HR 0.66, p=0.099; MDACC cohort: response rate 62% vsKRAS24%; PFS 7.4 vsKRAS2.8 months, HR 0.36, p=0.026).KRASG12C and non-G12C subgroups had similar clinical benefit from ICB in both cohorts. In a multivariable analysis,BRAFV600E mutation (HR 0.58, p=0.041), PD-L1 expression (HR 0.57, p=0.022), and high TMB (HR 0.66, p<0.001) were associated with longer PFS. High TMB and PD-L1 expression are predictive for benefit from ICB treatment in oncogene-driven NSCLCs. NSCLC harboringBRAFmutations demonstrated superior benefit from ICB that may be attributed to higher TMB and higher PD-L1 expression in these tumors. MeanwhileEGFRandHER2mutations andALK,ROS1,RET, andMETfusions define NSCLC subsets with minimal benefit from ICB despite high PD-L1 expression in NSCLC harboring oncogene fusions. These findings indicate a TMB/PD-L1-independent impact on sensitivity to ICB for certain oncogene alterations.
KW - immunotherapy
KW - lung neoplasms
KW - tumor biomarkers
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U2 - 10.1136/jitc-2021-002891
DO - 10.1136/jitc-2021-002891
M3 - Article
C2 - 34376553
AN - SCOPUS:85112775233
SN - 2051-1426
VL - 9
JO - Journal for immunotherapy of cancer
JF - Journal for immunotherapy of cancer
IS - 8
M1 - e002891
ER -