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. 2022 Nov 14;22(1):1175.
doi: 10.1186/s12885-022-10236-9.

A single center analysis of first-line treatment in advanced KRAS mutant non-small cell lung cancer: real-world practice

Yanxia Liu #  1   2 , Yuan Gao #  1 , Ying Wang  1 , Cong Zhao  1   2 , Zhiyun Zhang  1   2 , Baolan Li  3 , Tongmei Zhang  4
Affiliations

A single center analysis of first-line treatment in advanced KRAS mutant non-small cell lung cancer: real-world practice

Yanxia Liu et al. BMC Cancer. .

Abstract

Purpose: For the first-line treatment of KRAS mutant non-small cell lung cancer (NSCLC) patients, immunotherapy or platinum-based chemotherapy are the main treatment method. Here, we investigated the clinical efficacy and prognosis those two regimens as first-line treatment in real-world practice.

Methods: KRAS mutant NSCLC patients received chemotherapy or immunotherapy as first-line treatment from September 2014 to March 2022 were enrolled. Clinical characteristics, treatment scheme, clinical curative effect and follow-up data of enrolled patients were collected for analysis.

Results: Fifty patients received immunotherapy and 115 patients received chemotherapy were enrolled. Patients who received immunotherapy (HR = 0.350, 95%CI 0.156-0.781, P = 0.010), or pemetrexed-based regimen (HR = 0.486, 95%CI 0.255-0.928, P = 0.029), or antiangiogenic therapy (HR = 0.355, 95%CI 0.159-0.790, P = 0.011) were at a low risk of disease progression. And patients received antiangiogenic therapy had lower risk of death than those not (HR = 0.333, 95%CI 0.120-0.926, P = 0.035). Subgroup analysis revealed the immunotherapy compared to chemotherapy alone had lower risk of disease progression (HR = 0.377, 95%CI 0.166-0.856, P = 0.020) in PD-L1 expression ≥1% subgroup. And in non-G12C KRAS subgroup, but not in G12C KRAS subgroup, patients who received antiangiogenic therapy had lower risk of disease progression (HR = 0.254, 95%CI 0.098-0.656, P = 0.005) and death than those not (HR = 0.197, 95%CI 0.056-0.692, P = 0.011). In terms of different chemotherapy regimen, platinum-paclitaxel combined with antiangiogenic therapy achieved the highest ORR and DCR (P < 0.05), while the platinum-pemetrexed combined with antiangiogenic therapy had the longest PFS and OS (P < 0.001).

Conclusion: For the first-line treatment of KRAS mutant NSCLC patients, immunotherapy, antiangiogenic therapy, and pemetrexed-based regimen could obtain more benefits. Subgroup analysis revealed the benefits of immunotherapy compared to chemotherapy were applicable in PD-L1 expression≥1% subgroup, and antiangiogenic therapy could benefit non-G12C KRAS subgroup, but not G12C KRAS subgroup. In terms of different chemotherapy regimen, platinum-pemetrexed combined with antiangiogenic therapy may be the preferred chemotherapy regimen.

Keywords: Antiangiogenic therapy; First-line treatment; Immunotherapy; KRAS mutation; NSCLC.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design and patient enrollment flowchart
Fig. 2
Fig. 2
KRAS mutation subtypes in 160 NSCLC patients
Fig. 3
Fig. 3
PD-L1 expression between KRAS mutant NSCLC treated with immunotherapy and chemotherapy
Fig. 4
Fig. 4
Treatment regimens of KRAS mutant NSCLC patients
Fig. 5
Fig. 5
Survival curves of KRAS mutant NSCLC (A). The PFS survival curves between immunotherapy and chemotherapy group in KRAS mutant NSCLC patients (B). The PFS survival curves between treatment containing pemetrexed and containing paclitaxel in KRAS mutant NSCLC patients (C). The PFS survival curves between treatment with and without antiangiogenic therapy in KRAS mutant NSCLC patients (D). The OS survival curves between immunotherapy and chemotherapy group in KRAS mutant NSCLC patients (E). The OS survival curves between treatment containing pemetrexed and containing paclitaxel in KRAS mutant NSCLC patients (F). The OS survival curves between treatment with and without antiangiogenic therapy in KRAS mutant NSCLC patients (G). The PFS survival curves between immunotherapy and chemotherapy group in expression≥1% subgroup (H). The PFS survival curves between treatment with and without antiangiogenic therapy in non-G12C KRAS subgroup (I). The OS survival curves between treatment with and without antiangiogenic therapy in non-G12C KRAS subgroup
Fig. 6
Fig. 6
Survival curves of KRAS mutant NSCLC treated with chemotherapy (A). The PFS survival curves between the PEM and TAX group (B). The OS survival curves between the PEM and TAX group (C). The PFS survival curves between the AT and non-AT group (D). The OS survival curves between the AT and non-AT group (E). The PFS survival curves of different chemotherapy scheme (F). The OS survival curves of different chemotherapy scheme
Fig. 7
Fig. 7
PD-L1 expression among the immunotherapy groups
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