Abstract 940: Comprehensive characterization of MET exon 14 skipping mutations in non-small cell lung cancer

Abstract

Abstract Background: MET exon 14 skipping mutation (METΔex14) is a key driver event in non-small cell lung cancer (NSCLC), and can be acquired following drug resistance to MET, EGFR or ALK inhibitors. Clinical and genomic features of METΔex14 in NSCLC remain to be further characterized. Methods: A total of 556 baseline samples, 54 MET inhibitor-resistant samples and 16 EGFR/ALK inhibitor-resistant samples from 586 METΔex14 NSCLC patients were included in the analysis. Tissue and/or plasma samples were subjected to targeted next-generation sequencing (NGS) using Geneseeq’s 139/425 cancer-relevant gene panels. Results: The overall frequency of METΔex14 was 1.1%, with a total of 266 distinct variants detected. Of these, 40.2% were base substitutions in the intronic non-coding region immediately adjacent to the splice acceptor site, followed by indels (25.6%) and base substitutions (4.5%) in the splice donor site, and indels (21.4%) and base substitutions (2.3%) in the splice acceptor site, etc. No associations with clinical features were found among different variants. At baseline, METΔex14 commonly co-occurred with TP53 mutations (40.8%), and CDK4 (15.8%) and MET (7.9%) amplifications. In 42 (7.6%) patients, concurrent oncogenic mutations in EGFR, KRAS, ALK, RET, BRAF, and ERBB2 were also detected. Such patients displayed a different spectrum of METΔex14 variants compared with those without concurrent oncogenic mutations (P=0.08). In patients treated with MET inhibitors, no difference in survival was seen among different METΔex14 variants (P=0.38). Notably, activation of EGFR or MET (kinase domain mutations/amplification) conferred primary resistance to savolitinib and crizotinib. In addition, patients with high chromosomal instability or low intratumoral heterogeneity had unfavorable PFS. Secondary resistance to MET-TKI included MET activation (D1228N/H, Y1230C/S, amplification), EGFR activating mutations/amplification, KRAS G12V, as well as FGFR2/4 amplification. Surprisingly, we identified a FGFR3-TACC3 fusion as a previously unreported secondary resistance mechanism to savolitinib in the second line setting. Finally, we found that MET exon 14 skipping mutation might be a rare secondary resistance mechanism to EGFR/ALK inhibitors. Conclusion: In this study, we characterized METΔex14 in a large cohort of NSCLC patients and explored potential primary and secondary resistance mechanisms to savolitinib and crizotinib, which may facilitate drug development and help inform clinical actions. Citation Format: Xue Wu, Yaru Zhang, Jiaohui Pang, Li Lin, Jiani C. Yin, Haimeng Tang, Yang Shao. Comprehensive characterization of MET exon 14 skipping mutations in non-small cell lung cancer [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 940.