PP01.107 Patient Characteristics and Treatment Patterns in Biomarker Selected Early Non-Small Cell Lung Cancer

Document Type

Conference Proceeding

Publication Date

7-1-2024

Publication Title

J Thorac Oncol

Abstract

Background: Modern treatment of advanced non-small cell lung cancer (aNSCLC) is defined by a complex biomarker landscape. Lung driver mutation (LDM) selectivity in the treatment of early-stage disease (eNSCLC) is anticipated to become more involved, with one targeted therapy approved and several trials underway. Primarily because of data limitations, current understanding of the role of LDMs in eNSCLC pathology remains limited. Methods: We conducted a retrospective analysis of resected patients with stage I-IIIa NSCLC diagnosed between 2011-2023. We used the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine lung clinico-genomic database. Data originated from approximately 280 US cancer clinics (∼800 sites of care). We partitioned patients into five groups defined by LDM status: ALK+, EGFR+, KRASG12C+, KRASnon-G12C+ and wild-type (WT - negative for the listed biomarkers). We used descriptive statistics to characterize clinical and demographic attributes and treatment patterns. Results: We identified 1,916 stage I-IIIa patients with known LDM status. Of these, 2.2%, 16.4%, 23.8%, and 57.6% were ALK+, EGFR+, KRAS+, and WT. Median (IQR) follow-up was 29.6 (14.3, 56.3) months. Most patients were treated in the community setting (87%), had commercial insurance (55%), and were white (67%). Patients with ALK alterations were younger than others (median age 61 vs. 67 years). Smoking history was common in KRASG12C+, KRASnon-G12C+, and WT patients (96%, 86%, 88%), and less common in ALK+ and EGFR+ patients (49% and 50% respectively). KRASG12C+ represented 35.7% of the KRAS variants. KRAS non-G12C was most common in stage I and stage III patients, and EGFR was most common in stage II patients. Mutations were most common in Asian patients (67% positive for any LDM) versus 40-42% for others. All alterations were more common in females than in males (48.5% vs 34.0% positive for any LDM). ALK+ and EGFR+ were more common among Asian patients (7.0% and 47.7% prevalence, respectively, versus 2.0% and 14.7% of non-Asian patients). LDMs were more frequently detected in adenocarcinoma compared to squamous histology. However, KRAS was more frequently detected in squamous compared to other LDMs (KRAS G12C 3.7%, non-G12C 2.4%). Half of patients received no adjuvant treatment; 38% received adjuvant chemotherapy, with no apparent differences by LDM status. The most common regimen was cisplatin and pemetrexed, followed by carboplatin and pemetrexed. Conclusions: Stratification of eNSCLC patients by LDMs reveals substantial differences with respect to demographic and clinical characteristics.

Volume

19

First Page

e47

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