Abstract 6070: Comprehensive real-world-data based molecular profiling and mapping of non-squamous NSCLC patients to immune-checkpoint-inhibitor biomarkers

Abstract

Abstract Purpose: Non-squamous non-small cell lung cancer (nsqNSCLC) patients without detectable actionable alterations in EGFR, ALK, or ROS1, have a diverse genetic background. These patients are eligible to and usually receive untargeted, first line immune checkpoint inhibitors (ICI) and/or chemotherapy with heterogeneous outcomes. To identify potential predictive biomarkers for the stratification of nsqNSCLC patients without actionable genetic alterations, a comprehensive molecular profiling of this subpopulation was performed using the Foundation Medicine genomic database. Methods: Molecular profiles from 53,119 nsqNSCLC patients were analyzed using the FoundationInsightsTM web platform. After the patients with known and likely functional short variants for EGFR and fusions for ALK and ROS1 were excluded, the prevalences for commonly altered genes were determined. Pathway analysis was conducted with Metascape. Statistical significance and enrichment in PD-L1 and tumor mutation burden (TMB) biomarker overlap with altered genes was calculated using a fisher exact test against an alteration negative cohort. Results: nsqNSCLC patients without actionable genetic alterations can be described as a heterogenous population with different genetic alterations. We found a total of 103 genes with an individual, minimal prevalence of >1% to be the major descriptors that collectively were found in most patients of the nsqNSCLC subpopulation. These genes relate to pathways involved in cell cycle, cell proliferation, response to growth factors or chromatin organization. Out of the most frequently altered genes, we identified those that are associated with PD-L1 or TMB high status for which ICI treatment is most effective in nsqNSCLC. Conclusions: The results supported the lack of a general association with high PD-L1 and high TMB calls for biomarker informed treatment options for nsqNSCLC patients. We reported a subpopulation of nsqNSCLC patients that can be described by certain genetic alteration, of which some were associated with ICI-related biomarkers for which patients might benefit from a future precision oncology approach utilizing combined targeted and ICI treatment. Citation Format: Andreas Kloetgen, Danyi Wang, Anna Coenen-Stass, Ioannis Gounaris, Julia F. Hopkins, Giuseppe Locatelli, Juergen Scheuenpflug, Zheng Feng. Comprehensive real-world-data based molecular profiling and mapping of non-squamous NSCLC patients to immune-checkpoint-inhibitor biomarkers. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6070.