Non-small Cell Lung Cancer Population Research Articles

Prognostic implications of STK11 with different mutation status and its relationship with tumor-infiltrating immune cells in non-small cell lung cancer.

Mutations in STK11 (STK11Mut) gene may present a negative impact on survival in Non-small Cell Lung Cancer (NSCLC) patients, however, its relationship with immune related genes remains unclear. This study is to unveil whether overexpressed- and mutated-STK11 impact survival in NSCLC and to explore whether immune related genes (IRGs) are involved in STK11 mutations. 188 NSCLC patients with intact formalin-fixed paraffin-embedded (FFPE) tissue available for detecting STK11 protein expression were included in the analysis. After immunohistochemical detection of STK11 protein, patients were divided into high STK11 expression group (STK11High) and low STK11 expression group (STK11Low), and then Kaplan-Meier survival analysis and COX proportional hazards model were used to compare the overall survival (OS) and progression-free survival (PFS) of the two groups of patients. In addition, the mutation data from the TCGA database was used to categorize the NSCLC population, namely STK11 Mutated (STK11Mut) and wild-type (STK11Wt) subgroups. The difference in OS between STK11Mut and STK11Wt was compared. Finally, bioinformatics analysis was used to compare the differences in IRGs expression between STK11Mut and STK11Wt populations. The median follow-up time was 51.0 months (range 3.0 - 120.0 months) for real-life cohort. At the end of follow-up, 64.36% (121/188) of patients experienced recurrence or metastasis. 64.89% (122/188) of patients ended up in cancer-related death. High expression of STK11 was a significant protective factor for NSCLC patients, both in terms of PFS [HR=0.42, 95% CI= (0.29-0.61), P<0.001] and OS [HR=0.36, 95% CI= (0.25, 0.53), P<0.001], which was consistent with the finding in TCGA cohorts [HR=0.76, 95%CI= (0.65, 0.88), P<0.001 HR=0.76, 95%CI= (0.65, 0.88), P<0.001]. In TCGA cohort, STK11 mutation was a significant risk factor for NSCLC in both lung squamous cell carcinoma (LUSC) and lung adenocarcinoma (LUAD) histology in terms of OS [HR=6.81, 95%CI= (2.16, 21.53), P<0.001; HR=1.50, 95%CI= (1.00, 2.26), P=0.051, respectively]. Furthermore, 7 IRGs, namely CALCA, BMP6, S100P, THPO, CGA, PCSK1 and MUC5AC, were found significantly overexpressed in STK11-mutated NSCLC in both LUSC and LUAD histology. Low STK11 expression at protein level and presence of STK11 mutation were associated with poor prognosis in NSCLC, and mutated STK11 might probably alter the expression IRGs profiling.

Abstract 101: A novel humanized mouse model recapitulates the unique TME found in patients with HIV-associated NSCLC

Abstract Among people with HIV (PWH), non-small cell lung cancer (NSCLC) is increasing in incidence, presents with more advanced disease, and portends a worse prognosis compared to the general NSCLC population. Despite effective control of viral replication with antiretroviral therapy (ART), PWH have evidence of immune dysfunction, and it is unknown whether these immune perturbations impact the tumor microenvironment (TME) to influence disease disparities.Here we preclinically model HIV-associated NSCLC using MISTRG6-A2, a humanized mouse system that is highly optimized for development of functional innate and adaptive immune cells. We compare tumor growth and immune features of HIV-infected, ART-suppressed MISTRG6-A2 hosts to uninfected hosts, with parameters informed by parallel analyses of human tissue samples obtained from PWH with NSCLC, and non-HIV controls.MISTRG6-A2 mice were engrafted with human CD34+ HSPCs from HLA-A*02-expressing donors on post-natal day 2 and intravenously infected with HIV-1 at 6 weeks of age. When HIV viral titers were &amp;gt;106 copies of viral RNA/ml plasma and hCD4 T cells were depleted, ART was initiated (RAL/FTC/TDF). When plasma viral RNA was undetectable and CD4 T cells recovered, NSCLC PDX tissue from HLA-A*02-expressing tumor was implanted into these HIV-infected, ART-suppressed MISTRG6-A2 mice as well as non-infected littermate controls which had received HSPCs from the same donor. HIV-infected mice displayed enhanced growth of PDX tissue (mean tumor size 206.7 mm3 vs 110.2 mm3; p &amp;lt; 0.05).Quantitative immunofluorescence of the TME from these hosts revealed significantly increased infiltration of CD4 and CD8 T cells in tumors of HIV-NSCLC mice (p&amp;lt;0.01 and 0.05, respectively); of note, enhanced T cell infiltration was restricted to tumors, with similar frequency of CD4 and CD8 T cells detected in spleen, lung and liver tissues of HIV-infected vs uninfected hosts. Staining of tumor epitopes revealed increased expression of B2M and EGFR in tumors from HIV-NSCLC mice (mean qIF scores in NSCLC vs HIV-NSCLC 3.8 × 106 vs 1.2 × 107 for B2M, p&amp;lt;0.001; 440 vs 1,971 for EGFR, p&amp;lt;0.01), consistent with our findings in samples from HIV-NSCLC tumor tissues vs NSCLC tumor tissues. Of note, elevated EGFR staining was only present in tumor tissue, not found in stromal cells or other tissues. Single cell transcriptomic analyses of the TME revealed prominent interferon and antigen presentation signatures in HIV-NSCLC tumors, as well as differential expression of immunoregulatory molecules.These results demonstrate the fidelity of the HIV-NSCLC MISTRG6-A2 system as a model for HIV-associated NSCLC and suggest EGFR-directed therapies as potentially relevant in this neglected disease. Citation Format: Melani Juric, Gabriel Kaufmann, Li Zhu, Kishu Ranjan, Kriti Agrawal, Barani Kumar Rajendran, Jyothi K. Rajashekar, Hongyu Zhao, Yuval Kluger, Brinda Emu, Kurt A. Schalper, Priti Kumar, Richard A. Flavell, Michael Chiorazzi. A novel humanized mouse model recapitulates the unique TME found in patients with HIV-associated NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 101.

Abstract 6111: Real world incidence of ALK alterations in Hispanic NSCLC patients in Los Angeles

Abstract Introduction: Race and ethnicity affect the distribution of molecular alterations seen in populations of lung cancer patients. ALK fusions occur in 4-5% of non-small cell lung cancer (NSCLC) patients overall. We characterized ALK alteration presence in NSCLC Hispanics treated at a large academic institution in Los Angeles. Methods: 607 NSCLC patients treated at Los Angeles General Medical Center (LAGMC) (n=174) and Norris Comprehensive Cancer Center (NCCC) (n=433) who received comprehensive genomic profiling (CGP) were evaluated from July 2017 to June 2023. Fisher’s exact test was done to compare differences in prevalence between Hispanics and non-Hispanics. Multivariate logistic regression was performed to evaluate the role of Hispanic ethnicity controlling for site of treatment, age at initial diagnosis, sex, and smoking history. Results: Hispanics represented 23% (n=141) and 7.2% of patients (n=44) had ALK alterations (Table 1). Hispanics (12.76%, n = 18/141) were more likely to have ALK alterations than Non-Hispanics (5.58%, n = 26/466) (p=0.0083). In 18 Hispanic ALK patients, the median age was 53 years, 50% female (n=9), and 61.11% never smokers (n=11) versus a median age of 62.1 years, 46.80% female (n=66), and 53.19% never smokers (n=75) in all Hispanics (n=141). 94.44% of ALK Hispanics (n=17) were diagnosed as Stage IV versus 72.34% (n=102) in all Hispanics. Brain metastasis was seen in 61.11% (n=11) of Hispanic ALK patients versus 33.33% (n=47) in all Hispanics. Multivariate logistic regression showed Hispanic ethnicity HR 2.338 (95% CI 1.105-4.907) and age at diagnosis HR 0.9275 (95% CI 0.9025-0.9519) were significant variables in ALK alteration incidence. Conclusions: Hispanics represented 23% of the NSCLC population tested for CGP but 41% of the ALK altered patients. This highlights the need to study Hispanic ethnicity in the biology of ALK alterations, ensure Hispanics have equal access to CGP, and greater Hispanic representation in ALK inhibitor clinical trials. Clinical Characteristics of NSCLC patients at LAGMC and NCCC receiving CGP Hispanic Asian Non-Hispanic Black Non-Hispanic White Other/Unknown Total Number of ALK alterations (%) 18 (12.76%) 9 (4.41%) 0 (0.00%) 15 (8.24%) 2 (4.44%) 44 (7.2%) Total Population 141 204 35 182 45 607 Median Age of Diagnosis ALK population 53 52 - 55 51.5 53 Total population 62.1 66.1 63.6 68.4 65.6 65.7 Sex Females in ALK population (%) 9 (50.00%) 5 (55.56%) - 8 (53.33%) 1 (50.00%) 23 (52.27%) Females in total population (%) 66 (46.80%) 105 (51.47%) 14 (40.00%) 89 (48.90%) 20 (44.44%) 294 (48.43%) Smoking History Never smoker in ALK population (%) 11 (61.11%) 7 (77.78%) - 10 (66.67%) 1 (50.00%) 29 (65.90%) Never smoker in total population (%) 75 (53.19%) 122 (59.80%) 8 (22.86%) 55 (30.22%) 18 (40.00%) 278 (45.80%) Histology Adenocarcinoma in ALK population (%) 17 (94.44%) 7 (77.78%) - 14 (93.33%) 0 (0.00%) 38 (86.36%) 114 (80.85%) 161 (78.92%) 25 (71.43%) 121 (66.48%) 30 (66.67%) 451 (74.30%) Stage Stage IV at diagnosis in ALK population (%) 17 (94.44%) 7 (77.78%) - 13 (86.67%) 2 (100.00%) 39 (88.64%) Stage IV at diagnosis in total population (%) 102 (72.34%) 113 (55.39%) 16 (45.71%) 95 (52.20%) 22 (48.89%) 348 (57.33%) Brain Metastasis Brain metastasis in ALK population (%) 11 (61.11%) 2 (22.22%) - 8 (53.33%) 2 (100.00%) 23 (52.28%) Brain metastasis in total population (%) 47 (33.33%) 57 (27.94%) 10 (28.57%) 38 (20.88%) 6 (13.33%) 158 (26.0%) Citation Format: Robert C. Hsu, Darin Poei, Jacob S. Thomas, Jorge J. Nieva. Real world incidence of ALK alterations in Hispanic NSCLC patients in Los Angeles [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6111.

Immunotherapy in Elderly Patients-Single-Center Experience.

Cancer management faces a substantial challenge posed by the aging demographic. Aging is marked by accumulated DNA damage, and this phenomenon is implicated in the process of tumorigenesis. The concept of immunosenescence, postulated to manifest in elderly individuals, is defined by an age-related decline in T cells and a simultaneous elevation in proinflammatory status, leading to a diminished efficacy in response to immunotherapy. Notably, despite the rising prevalence of cancer in the elderly population, their underrepresentation in clinical trials persists. This underscores the unmet need to evaluate the safety and efficacy of cancer treatment in the elderly. This retrospective, single-center cohort study aimed to assess and evaluate the effectiveness and safety of immunotherapy in patients compared to younger individuals with metastatic solid tumors receiving ICI. A total of 220 patients were included, mostly males, with a median age of 64. The proportion of patients ≥ 65 years old was 56.5%. The use of ICI showed no significant differences concerning overall survival (OS) and progression-free survival (PFS) among age groups across different cancer types (melanoma, non-small-cell lung cancer (NSCLC), renal, and bladder cancer; p = 0.388). Concerning the response to treatment in renal cancer patients, a significant difference was observed (p = 0.041), suggesting a potential negative impact of age on the treatment response. In patients that presented immune-related adverse events (irAEs), oral corticosteroid therapy was marginally associated (p = 0.059) with the elderly population. When evaluating the NSCLC population alone (n = 131, 59.5%), our study revealed a strong association between the development of irAEs, patients' PFS and OS, and the duration of ICI treatment, but not directly correlated with age. The NSCLC elderly population presented a marginally greater number of irAEs, although without statistical significance (p = 0.86). ICI maintained efficacy and safety in elderly patients, challenging the notion that age alone should determine treatment decisions. The findings emphasize the necessity of a comprehensive geriatric assessment rather than relying solely on chronological age for personalized cancer treatment in the elderly population. Further prospective studies are needed to better understand immune responses in older adults and derive predictive biomarkers for cancer treatment.

Abstract B042: Efficacy and safety outcomes of ABN401 in NSCLC patients with MET Exon 14 Skipping: A clinically relevant subgroup analysis

Abstract Background: In non-small-cell lung cancer (NSCLC), approximately 3-4% of patients exhibit MET exon 14 skipping (METex14) mutations. ABN401, a selective type I MET kinase inhibitor, has demonstrated promising antitumor activity and safety in advanced solid tumor patients. Here, we report updated outcomes of ABN401, focusing on METex14 NSCLC patients. Methods: Patients enrolled in the ABN401 Phase I (NCT04052971) and Phase II (NCT05541822) trials were analyzed. The safety population consists of all patients who have been dosed at ABN401 800 mg QD, while the efficacy population comprises METex14 NSCLC patients dosed at 800 mg QD. The primary objective for phase I study was safety, and for phase II study was the objective response rate (ORR) in patients. Secondary objectives include recommended dose and regimen of ABN401, PK and preliminary efficacy of ABN401 for phase I and duration of response (DOR), objective disease control rate (DCR), progression free survival (PFS), overall survival (OS), PK, safety, and tolerability of ABN401 for phase II. Results: Between June 23, 2022, and July 6, 2023, a total of 24 patients received ABN401 800 mg QD, including 17 METex14 NSCLC patients. Of 24 patients evaluable for safety, 2 (8.3%) experienced grades ≥3 treatment-related adverse events (TRAE). The most common treatment-related adverse events were nausea (70.8%), vomiting (29.2%), and diarrhea (33.3%). Grade ≥3 treatment-emergent adverse events occurred in 5/24 (20.8%) patients. Treatment-related adverse events leading to permanent discontinuation occurred in 0% (0/24) of patients. Peripheral edema was observed in 29.2% (grade 1-2) and there was no grade 3 or greater event in all safety evaluable populations, and 17.6% (grade 1-2) and 0% (grade 3) in METex14 NSCLC population. For the 17 METex14 NSCLC patients, one was not evaluable because the patient did not had the first tumor assessment at the time of DCO. The median age is 69 (41-81) and 70.6% were male, with 1 (0-3) as the median prior lines of treatment. 41.2% of 17 patients were ex-smoker and 58.8% were non-smoker. All patients were MET inhibitor naïve. The objective response rate was 56.2% (9/16) in the evaluable population. Overall (n = 9), 66.7% is treatment-naïve patients (n = 6). The median duration of treatment was 5.4 months for all who dosed 800 mg QD as of the data cut-off on July 6, 2023. At the time of DCO, data is not mature enough for PFS and DoR. Conclusions: ABN401 has shown promise in antitumor efficacy and favorable toxicity in patients with locally advanced or metastatic METex14 NSCLC. The phase 2 multicenter, open-label trial (NCT05541822) is actively enrolling in the US, South Korea, and Taiwan. Citation Format: Se-Hoon Lee, Ji-Youn Han, Ki Hyeong Lee, Gyeong-Won Lee, Charlotte Lemech, Michael Millward, Aflah Roohullah, Xiuning Le, Keunchil Park, Jun Young Choi, Na Young Kim, Sunyhe Im, Nirmal Rajasekaran, Kyung Eui Park, Sangsuk Lee, Hanlim Moon, Sunjin Hwang, YoungKee Shin, Dae Ho Lee. Efficacy and safety outcomes of ABN401 in NSCLC patients with MET Exon 14 Skipping: A clinically relevant subgroup analysis [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr B042.

Nivolumab plus chemotherapy in first-line metastatic non-small-cell lung cancer: results of the phase III CheckMate 227 Part 2 trial

In CheckMate 227 Part 1, first-line nivolumab plus ipilimumab prolonged overall survival (OS) in patients with metastatic non-small-cell lung cancer (NSCLC) and tumor programmed death-ligand 1 (PD-L1) expression ≥1% versus chemotherapy. We report results from CheckMate 227 Part 2, which evaluated nivolumab plus chemotherapy versus chemotherapy in patients with metastatic NSCLC regardless of tumor PD-L1 expression. Seven hundred and fifty-five patients with systemic therapy-naive, stage IV/recurrent NSCLC without EGFR mutations or ALK alterations were randomized 1 : 1 to nivolumab 360 mg every 3 weeks plus chemotherapy or chemotherapy. Primary endpoint was OS with nivolumab plus chemotherapy versus chemotherapy in patients with nonsquamous NSCLC. OS in all randomized patients was a hierarchically tested secondary endpoint. At 19.5 months' minimum follow-up, no significant improvement in OS was seen with nivolumab plus chemotherapy versus chemotherapy in patients with nonsquamous NSCLC [median OS 18.8 versus 15.6 months, hazard ratio (HR) 0.86, 95.62% confidence interval (CI) 0.69-1.08, P= 0.1859]. Descriptive analyses showed OS improvement with nivolumab plus chemotherapy versus chemotherapy in all randomized patients (median OS 18.3 versus 14.7 months, HR 0.81, 95.62% CI 0.67-0.97) and in an exploratory analysis in squamous NSCLC (median OS 18.3 versus 12.0 months, HR 0.69, 95% CI 0.50-0.97). A trend toward improved OS was seen with nivolumab plus chemotherapy versus chemotherapy, regardless of the tumor mutation status of STK11 or TP53, regardless of tumor mutational burden, and in patients with intermediate/poor Lung Immune Prognostic Index scores. Safety with nivolumab plus chemotherapy was consistent with previous reports of first-line settings. CheckMate 227 Part 2 did not meet the primary endpoint of OS with nivolumab plus chemotherapy versus chemotherapy in patients with metastatic nonsquamous NSCLC. Descriptive analyses showed prolonged OS with nivolumab plus chemotherapy in all-randomized and squamous NSCLC populations, suggesting that this combination may benefit patients with untreated metastatic NSCLC.

Hope and Challenges: Immunotherapy in EGFR-Mutant NSCLC Patients.

EGFR tyrosine kinase inhibitors (TKIs) are the preferred initial treatment for non-small cell lung cancer (NSCLC) patients harboring sensitive EGFR mutations. Sadly, remission is transient, and no approved effective treatment options are available for EGFR-TKI-advanced EGFR-mutant NSCLCs. Although immunotherapy with immune checkpoint inhibitors (ICIs) induces sustained cancer remission in a subset of NSCLCs, ICI therapy exhibits limited activity in most EGFR-mutant NSCLCs. Mechanistically, the strong oncogenic EGFR signaling in EGFR-mutant NSCLCs contributes to a non-inflamed tumor immune microenvironment (TIME), characterized by a limited number of CD8+ T cell infiltration, a high number of regulatory CD4+ T cells, and an increased number of inactivated infiltrated T cells. Additionally, EGFR-mutant NSCLC patients are generally non-smokers with low levels of PD-L1 expression and tumor mutation burden. Promisingly, a small population of EGFR-mutant NSCLCs still durably respond to ICI therapy. The hope of ICI therapy from pre-clinical studies and clinical trials is reviewed in EGFR-mutant NSCLCs. The challenges of application ICI therapy in EGFR-mutant NSCLCs are also reviewed.

Representativeness of Patients Enrolled in the Lung Cancer Master Protocol (Lung-MAP).

Lung Cancer Master Protocol (Lung-MAP), a public-private partnership, established infrastructure for conducting a biomarker-driven master protocol in molecularly targeted therapies. We compared characteristics of patients enrolled in Lung-MAP with those of patients in advanced non-small-cell lung cancer (NSCLC) trials to examine if master protocols improve trial access. We examined patients enrolled in Lung-MAP (2014-2020) according to sociodemographic characteristics. Proportions for characteristics were compared with those for a set of advanced NSCLC trials (2001-2020) and the US advanced NSCLC population using SEER registry data (2014-2018). Characteristics of patients enrolled in Lung-MAP treatment substudies were examined in subgroup analysis. Two-sided tests of proportions at an alpha of .01 were used for all comparisons. A total of 3,556 patients enrolled in Lung-MAP were compared with 2,215 patients enrolled in other NSCLC studies. Patients enrolled in Lung-MAP were more likely to be 65 years and older (57.2% v 46.3%; P < .0001), from rural areas (17.3% v 14.4%; P = .004), and from socioeconomically deprived neighborhoods (42.2% v 36.7%, P < .0001), but less likely to be female (38.6% v 47.2%; P < .0001), Asian (2.8% v 5.1%; P < .0001), or Hispanic (2.4% v 3.8%; P = .003). Among patients younger than 65 years, Lung-MAP enrolled more patients using Medicaid/no insurance (27.6% v 17.8%; P < .0001). Compared with the US advanced NSCLC population, Lung-MAP under represented patients 65 years and older (57.2% v 69.8%; P < .0001), females (38.6% v 46.0%; P < .0001), and racial or ethnic minorities (14.8% v 21.5%; P < .0001). Master protocols may improve access to trials using novel therapeutics for older patients and socioeconomically vulnerable patients compared with conventional trials, but specific patient exclusion criteria influenced demographic composition. Further research examining participation barriers for under represented racial or ethnic minorities in precision medicine clinical trials is warranted.

Immune Checkpoint Inhibitors in "Special" NSCLC Populations: A Viable Approach?

Over the last decade, the therapeutic scenario for advanced non-small-cell lung cancer (NSCLC) has undergone a major paradigm shift. Immune checkpoint inhibitors (ICIs) have shown a meaningful clinical and survival improvement in different settings of the disease. However, the real benefit of this therapeutic approach remains controversial in selected NSCLC subsets, such as those of the elderly with active brain metastases or oncogene-addicted mutations. This is mainly due to the exclusion or underrepresentation of these patient subpopulations in most pivotal phase III studies; this precludes the generalization of ICI efficacy in this context. Moreover, no predictive biomarkers of ICI response exist that can help with patient selection for this therapeutic approach. Here, we critically summarize the current state of ICI efficacy in the most common "special" NSCLC subpopulations.

Plasma Cell-free RNA PD-L1 and Survival with Immune Checkpoint Inhibitor Therapy in Metastatic Non-Small Cell Lung Cancer

Background: Tissue programmed death-ligand 1 (PD-L1) protein expression is predictive of immune checkpoint inhibitor (ICI) benefit. However, tissue testing can be fraught with tissue acquisition and heterogeneity limitations. Plasma testing can overcome these limitations. However, the overall survival predictive benefit of plasma PD-L1 assays have not been well characterized. Methods: Patients with stage IV non-small cell lung cancer (NSCLC) and plasma cell free RNA PD-L1 by polymerase chain reaction (PCR) expression were identified and assessed for overall survival. Sixteen patients treated with front-line ICI-based regimens were assessed and represented a real-world patient population with over half with a performance status of 2 or greater. Ten contemporaneous patients at the same institution treated with chemotherapy alone were also identified and assessed. With a median follow-up of 33 months, median overall survival was 13 months with a 30% 3-year OS for the ICI treated patients compared to a median OS of 3 months and a 10% 3- year OS for those treated with chemotherapy alone. Comparative log-rank test p-value = 0.014 and a hazard ratio 0.376 (95%-CI 0.134-1.057). Conclusions: A plasma cell free RNA PD-L1 by PCR assay was associated with a statistically significant survival benefit from ICI-based treatment compared to chemotherapy in the first line treatment of a real-world patient population of advanced NSCLC.

YAP1 as a Novel Negative Biomarker of Immune Checkpoint Inhibitors for EGFR-Mutant Non-Small-Cell Lung Cancer.

Immune checkpoint inhibitors (ICIs) have become a standard care in non-small-cell lung cancer (NSCLC). However, its application to epidermal growth factor receptor (EGFR)-mutant NSCLC patients is confronted with drug resistance. This study aimed to clarify the potential role of Yes1-associated transcriptional regulator (YAP1) in ICIs treatment for EGFR-mutant NSCLC population. All the clinical data of NSCLC were downloaded from Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) for GSE11969 and GSE72094. Based on YAP1 expression, all the NSCLC patients including the EGFR-mutant and EGFR-wildtype (WT) patients were divided into two groups, YAP1_High and YAP1_Low. Using cBioPortal, genetic alterations were analyzed for identification of immunogenicity in EGFR-mutant NSCLC. MR analysis was used to analyze the hub gene of EGFR. The infiltration of immune cells and the expression of the identified tumor-associated antigens were identified with TIMER. By graph learning-based dimensionality reduction analysis, the immune landscape was visualized. Moreover, survival analysis was performed to verify the predictive value of YAP1 in ICIs treatment for EGFR-mutant NSCLC population using Ren's research data (NCT03513666). YAP1 was a poor prognostic factor of EGFR-mutant NSCLC population rather than lung adenocarcinoma (LUAD) patients. MR analysis revealed that the EGFR gene regulated YAP1 expression. YAP1 was identified as a hub gene closely associated with immunosuppressive microenvironment and poor prognosis in EGFR-mutant NSCLC population in TCGA LUAD. Tumors with YAP1_High showed an immune-"cold" and immunosuppressive phenotype, whereas those with YAP1_Low demonstrated an immune-"hot" and immunoactive phenotype. More importantly, it was verified that YAP1_High subpopulation had a significantly shorter progression-free survival (PFS) and overall survival (OS) after ICIs treatment in EGFR-mutant NSCLC patients in the clinical trial. YAP1 mediates immunosuppressive microenvironment and poor prognosis in EGFR-mutant NSCLC population. YAP1 is a novel negative biomarker of ICIs treatment in EGFR-mutant NSCLC population. Clinical Trials. This trial is registered with NCT03513666.

EE279 Real-World Evidence Relating Cytopenia Diagnosis to Hospitalization and Cost of Care in the Treatment of Non-Small Cell Lung Cancer Patients

Neutropenia is a driver of infection-related mortality in Non-Small Cell Lung Cancer (NSCLC) patients with chemotherapy-induced myelosuppression. Prior research found incident neutropenia in 24% of advanced NSCLC Medicare patients during first-line chemotherapy. Neutropenia-related care comprised up to one-third of total patient cost. We first confirmed the real-world incidence of cytopenia in an NSCLC population. Then we estimated the subsequent hospitalizations and total cost of care using OncoHealth Real-World Data (RWD). Our objective was to temporally sequence cytopenia diagnosis, hospitalization and accrual of costs to identify a window for targeting symptom management and patient engagement.

Prediction of brain metastases progression and overall survival in patients with metastatic non-small cell lung cancer treated by immune checkpoint inhibitors using a radiomic model.

e21169 Background: Brain metastases (BMs) incidence is high in patients with metastatic non-small cell lung cancer (NSCLC). Immune Checkpoints Inhibitors (ICIs) are now standard of care for metastatic NSCLC in the first-line or beyond settings. However, less than half of patients will have a tumor response, and the determinants of BMs response to ICIs remain unknown. This study aims to evaluate the value of radiomics to predict control/progression of BMs at a lesion level, and outcomes at a patient level in the BM+ NSCLC population treated by ICIs. Methods: We conducted a retrospective multicenter (5 European centers) study including consecutive patients with NSCLC BMs and available baseline MRI before ICIs (evaluation cohort) or chemotherapy (control cohort) with a 2:1 ratio, between 2011 and 2021. After modified RANO (Response Assessment in Neuro-Oncology) assessment of individual BMs, we developed a radiomic model to predict BMs control/progression to ICIs at the first brain follow-up imaging. The ICIs cohort was split into two datasets used for (i) model training with 5-fold cross-validation and (ii) model testing. The Chemotherapy cohort was used to ensure the specificity of our model to ICIs-treated patients. Results: Ninety-four and 49 patients were included in the ICIs and Chemotherapy cohorts respectively, of which 56 (59.6%, N = 227 BMs) and 39 (79.6%, N = 192 BMs) patients had available brain follow-up imaging. The ICIs cohort was specifically enriched in radiomic features which were significantly associated to BMs progression. Our final model, based on extreme gradient boosting (xgboost) on BMs &gt; 10mm from the training set (N = 39 BMs), could predict individual BMs progression to ICIs with an area under curve (AUC) of 0.77 (p-value = 0.029, 95% CI [0.56-0.98]) in the test set (N = 20 BMs). We further generated a radiomic score to stratify BM+ NSCLC ICIs-treated patients between High-Risk or Low-Risk groups according to the predicted individual BMs progression. High-risk patients were associated with worse overall survival (OS) (median OS of 6.3 months, 95% CI [3.02-10.49]) compared to Low-risk patients (median OS of 11.87 months, 95% CI [7.02-21.90], p = 0.042). The prognostic value of the radiomic score on OS was validated in a multivariate analysis in the ICIs cohort (Table). Conclusions: To our knowledge, this is the first study to explore the value of radiomics in the prediction of BMs response to immunotherapy. Prospective evaluation will confirm the generalizability of our model in clinical practice.[Table: see text]

CfDNA NGS detection of fusions acquired as mechanisms of resistance in the post-EGFR setting across multiple solid tumors.

3053 Background: Oncogenic fusions are rare but have targetable, FDA-approved therapies across all solid tumor types. These fusions have been associated with resistance to EGFR-TKI (EGFRi) in advanced non-small cell lung cancer (NSCLC) and anti-EGFR antibodies in colorectal cancer (CRC), but the prevalence of acquired fusions and their associated clinical outcomes have not been well-studied. We examined fusions in &gt;5,000 patients with advanced NSCLC or CRC who had a history of EGFR-directed therapy in the GuardantINFORM clinical-genomic database. Methods: Fusions in ALK, FGFR1-3, NTRK1-3, ROS1 and RET were examined in a cohort of 2,379 patients with NSCLC and 1,072 with CRC tested with Guardant360 or Guardant360 CDx (Guardant Health, Redwood City, CA) before approved EGFR-targeting therapies, and in 3,531 patients with NSCLC and 2,132 patients with CRC tested after EGFR therapy. Fusion clonality was calculated as the fusion variant allele fraction (VAF):max somatic VAF for each patient, with subclonal fusions defined as having clonality &lt; 0.5. Clinical outcomes were compared between patients with and without fusions in the post-EGFR population, adjusting for age, gender, regimen/line of therapy, and max VAF. Comparisons of fusion prevalence pre- and post-EGFR therapy were performed using Fisher’s exact test. Results: Fusions were detected more frequently in patients with NSCLC and CRC after EGFR therapy relative to pretreatment (NSCLC: 3.2% vs. pre-EGFR 0.5%, p&lt;0.05; CRC: 6.4% vs. pre-EGFR 1.1%, p&lt;0.05). Fusions in RET were most enriched in the post-EGFR NSCLC population (1.0% vs. pre-EGFR 0.1%, OR=11.6, p&lt;0.05), while fusions in the FGFR family were most enriched in the post-EGFR CRC population (3.0% vs. pre-EGFR 0.3%, OR=10.8, p&lt;0.05). The majority of fusions post-EGFR were subclonal in patients with NSCLC (86%) and CRC (96%), consistent with these fusions emerging as mechanisms of resistance. In patients with NSCLC, clinical outcomes (as measured by time-to-next-treatment (TTNT)) were significantly shorter in patients who acquired fusions compared to those without fusions (median 5.9 vs. 9.5 months, log-rank p=0.01, adjusted HR=1.7, adjusted p=0.02). Patients with CRC showed no significant difference in TTNT between those with and without acquired fusions. In patients with NSCLC who acquired fusions, 45% received an EGFRi in the next line and 23% received a TKI targeted to their fusion; TTNT on these therapies was not significantly different (median 5.3 months vs. 6.4 months, respectively). Conclusions: Fusions in patients with NSCLC and CRC were enriched post-EGFR therapy and were associated with inferior clinical outcomes in NSCLC. Recognition of the subclonal prevalence of acquired fusions provides important context as oncologists consider the next line of therapy. This work highlights the potential utility of genomic profiling in patients over the course of treatment.

Results from a first-in-human phase 1B study of a complement factor H inhibitor (GT103) in patients with non-small cell lung cancer (NSCLC).

9128 Background: GT103 is a first-in-class IgG3 monoclonal antibody that was derived from a single human B cell and inhibits complement factor H (CFH). CFH is implicated in cancer immune evasion and overexpression portends a poor prognosis in multiple malignancies. CFH regulates C3 convertase in the alternative pathway of the complement cascade, limiting downstream opsonization and membrane attack complex formation. Monoclonal antibody inhibition of CFH facilitates complement-dependent tumor cell lysis, modulates the adaptive immune response, and inhibits tumor growth. Methods: GT103 is being evaluated in a multi-institutional, first-in-human, phase Ib study in patients with advanced stage, refractory NSCLC. A standard ‘3+3’ dose escalation schema was used across four dose levels, with treatment given until disease progression or unacceptable toxicity. Dose limiting toxicity (DLT) observation period included cycle 1 and radiographic disease assessment was performed every 6 weeks. We have previously reported that no DLT was seen at the highest two dose levels of 3 mg /kg or 10 mg/kg administered IV every 3 weeks. Two expansion cohorts have now been opened at 10 mg/kg IV every 2 week and 15 mg/kg every 3 weeks dose levels allowing up to 6 patients at each dose level. We herein present updated clinical outcomes and analysis of correlative biomarkers. Results: As of February 3, 2023, twenty-five patients have been treated, with a median follow up of 230 days. Five of the 21 patients in the dose escalation cohort demonstrated stable disease by RECIST criteria. In the 10 mg/kg dose level, one patient has experienced prolonged disease stabilization and has received 12 cycles to date with tumor reduction on CT. The DLT period is ongoing for two patients enrolled in the 10 mg/kg IV every 2 weeks and two patients in the 15 mg/kg every 3 weeks expansion cohorts. Soluble C5b-9 (s C5b-9) is a candidate pharmacodynamic biomarker for GT103 and was measured at baseline and at day 15 from patients in all four dose escalation levels (0.3, 1, 3, 10 mg/kg). An increase in sC5b-9 was found in 13 of 21 patients at day 15. A marked doubling of the baseline sC5b-9 level was demonstrated in a subset of patients by day 15 indicative of biologic activity. Conclusions: GT103 is well tolerated in heavily pretreated advanced NSCLC population. Early clinical activity has been demonstrated to date with stable disease seen in 24% of patients. Updated clinical results and correlative data will be presented. A separate phase 2 study of combination GT103 with pembrolizumab is planned for patients with refractory NSCLC. Trial Registration: The study was approved by Duke University IRB with approval number Pro00104564. Clinical trial information: NCT04314089 .

Lymph Node Metastases in Surgically Resected Solitary Ground-Glass Opacities: A Two-Center Retrospective Cohort Study and Pooled Literature Analysis.

An increasing body of evidence supports the noninferiority of sublobar resection compared with lobectomy in terms of survival for patients with early-stage lung cancer with ground-glass opacities (GGOs). However, few studies have focused on the incidence of lymph node (LN) metastases in these patients. We aimed to analyze N1 and N2 lymph node involvement in patients with non-small cell lung cancer (NSCLC) with GGO components stratified with different consolidation tumor ratio (CTR). We performed two-center studies by retrospectively reviewing a total of 864 patients with NSCLC with semisolid or pure GGO manifestation (diameter≤3cm). Clinicopathologic features and outcomes were analyzed. We also reviewed 35 studies to characterize the patient with NSCLC population with the GGO manifestation. In both cohorts, there was no LN involvement for pure GGO NSCLC, while solid predominant GGO exhibited a relatively high LN involvement rate. On the basis of a pooled literature analysis, the incidence of pathologic mediastinal LN was 0% and 3.8% for pure and semisolid GGOs, respectively. GGO NSCLCs with CTR≤0.5 also had rare LN involvement (0.1%). From two cohorts and pooled literature analysis, LN involvement was not observed in patients with pure GGO, and very few patients with semisolid GGO NSCLC with CTR ≤0.5 had LN involvement, revealing that it may be unnecessary to perform lymphadenectomy for pure GGOs, while mediastinal lymph node sampling (MLNS) is enough for semisolid GGOs with CTR ≤0.5. For the patients with GGO CTR >0.5, mediastinal lymphadenectomy (MLD) or MLNS should be considered.

Spatial characterization and quantification of CD40 expression across cancer types

BackgroundCD40, a TNF receptor family member, is expressed by a variety of immune cells and is involved in the activation of both adaptive and innate immune responses. Here, we used quantitative immunofluorescence (QIF) to evaluate CD40 expression on the tumor epithelium of solid tumors in large patient cohorts of lung, ovarian, and pancreatic cancers.MethodsTissue samples from nine different solid tumors (bladder, breast, colon, gastric, head and neck, non-small cell lung cancer (NSCLC), ovarian, pancreatic and renal cell carcinoma), constructed in tissue microarray format, were initially assessed for CD40 expression by QIF. CD40 expression was then evaluated on the large available patient cohorts for three of the tumor types demonstrating high CD40 positivity rate; NSCLC, ovarian and pancreatic cancer. The prognostic impact of CD40 expression on tumor cells was also investigated.ResultsCD40 expression on tumor cells was found to be common, with 80% of the NSCLC population, 40% of the ovarian cancer population, and 68% of the pancreatic adenocarcinoma population displaying some degree of CD40 expression on cancer cells. All of three of these cancer types displayed considerable intra-tumoral heterogeneity of CD40 expression, as well as partial correlation between expression of CD40 on tumor cells and on surrounding stromal cells. CD40 was not found to be prognostic for overall survival in NSCLC, ovarian cancer, or pancreatic adenocarcinoma.ConclusionsThe high percentage of tumor cells expressing CD40 in each of these solid tumors should be considered in the development of therapeutic agents designed to target CD40.

KRAS G12C mutated advanced non-small cell lung cancer (NSCLC): Characteristics, treatment patterns and overall survival from a Danish nationwide observational register study

ObjectivesWe aimed to characterize the advanced NSCLC population in terms of KRAS G12C prevalence, patient characteristics, and survival outcomes after the introduction of immunotherapies. Materials and MethodsWe identified adult patients diagnosed with advanced NSCLC between January 1, 2018 and June 30, 2021 using the Danish health registries. Patients were grouped by mutational status (any KRAS mutation, KRAS G12C, and KRAS/EGFR/ALK wildtype [Triple WT]). We analyzed KRAS G12C prevalence, patient and tumor characteristics, treatment history, time-to-next-treatment (TTNT), and overall survival (OS). ResultsWe identified 7,440 patients of whom 40% (n = 2,969) were KRAS tested prior to the first line of therapy (LOT1). Among the KRAS tested, 11% (n = 328) harbored KRAS G12C. More KRAS G12C patients were women (67%), smokers (86%), had a high (≥50%) level of PD-L1 expression (54%), and more frequently received anti-PD-L1 treatment than any other group. From the date of the mutational test result, OS (7.1–7.3 months) was similar between the groups. OS from LOT1 (14.0 months) and LOT2 (10.8 months), and TTNT from LOT1 (6.9 months) and LOT2 (6.3 months) was numerically longer for the KRAS G12C mutated group compared to any other group. However, from LOT1 and LOT2, the OS and TTNT were comparable when stratifying the groups by PD-L1 expression level. Regardless of the mutational group, OS was markedly longer for patients with high PD-L1 expression. ConclusionIn patients diagnosed with advanced NSCLC after the implementation of anti-PD-1/L1 therapies, the survival in KRAS G12C mutated patients is comparable to patients with any KRAS mutation, Triple WT, and all NSCLC patients.

At the crossroads of immunotherapy for oncogene-addicted subsets of NSCLC.

Non-small-cell lung cancer (NSCLC) has become a paradigm of precision medicine, with the discovery of numerous disease subtypes defined by specific oncogenic driver mutations leading to the development of a range of molecularly targeted therapies. Over the past decade, rapid progress has also been made in the development of immune-checkpoint inhibitors (ICIs), especially antagonistic antibodies targeting the PD-L1-PD-1 axis, for the treatment of NSCLC. Although many of the major oncogenic drivers of NSCLC are associated with intrinsic resistance to ICIs, patients with certain oncogene-driven subtypes of the disease that are highly responsive to specific targeted therapies might also derive benefit from immunotherapy. However, the development of effective immunotherapy approaches for oncogene-addicted NSCLC has been challenged by a lack of predictive biomarkers for patient selection and limited knowledge of how ICIs and oncogene-directed targeted therapies should be combined. Therefore, whether ICIs alone or with chemotherapy or even in combination with molecularly targeted agents would offer comparable benefit in the context of selected oncogenic driver alterations to that observed in the general unselected NSCLC population remains an open question. In this Review, we discuss the effects of oncogenic driver mutations on the efficacy of ICIs and the immune tumour microenvironment as well as the potential vulnerabilities that could be exploited to overcome the challenges of immunotherapy for oncogene-addicted NSCLC.

Molecular epidemiology and clinical characteristics of epidermal growth factor receptor mutations in NSCLC: A single-center experience from India.

The genetic profiling of non-small cell lung cancer (NSCLC) has contributed to the discovery of actionable targetable mutations, which have significantly improved outcomes in disease with poor prognosis. Molecular epidemiological data of driver mutations in Indian populations have not been extensively elaborated compared to western and eastern Asian NSCLC populations. This study assessed the prevalence and clinical outcomes of EGFR (epidermal growth factor receptor) mutations among the Indian NSCLC cohort in South India. Retrospective analysis of 2,003 NSCLC patients who had undergone EGFR mutational analysis from 2013 to 2020 was performed. Clinical analysis was performed for 141 patients from 2013 to 2017 using Kaplan-Meier and Chi-square methods. Descriptive and survival statistics were performed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. EGFR-sensitizing mutations were detected in 41.6% (834/2003) in the study cohort with compound mutations detected in 7.55% (63/834) of EGFR-positive cases. A significant relationship with regard to female gender and EGFR mutation status (P <.001) was observed. Exon 18 G719X (8.7%) mutations and exon 20 T790M point mutation (3.1%) were the most frequently isolated uncommon EGFR mutations. In the clinical cohort, EGFR mutations were detected at a significantly higher prevalence in females (P =0.002) and never-smokers (P < 0.001). EGFR mutation demonstrated a significant relationship with regard to brain metastasis (P = 0.011). EGFR mutated individuals had significantly longer median overall survival compared to EGFR wild type (26 months vs. 12 months, P = 0.044). We reports the highest number of EGFR mutation analysis performed from India and mutational analysis indicated a loco-regional variation in India with regard to EGFR mutation frequency and its subtypes.