Chemoimmunotherapy may be preferable for KRAS wild-type NSCLC
medwireNews: Chemoimmunotherapy may be a better option than immune checkpoint inhibitor (ICI) monotherapy for advanced non-small-cell lung cancer (NSCLC) patients with high PD-L1 expression and no KRAS mutations, indicate findings.
Among patients receiving single-agent ICI therapy, overall survival (OS) was significantly prolonged for those with versus without KRAS variants, at a median of 21.1 and 13.6 months, respectively, and a hazard ratio for death of 0.77 after adjustment for variables such as age, sex, disease stage, and smoking history.
By contrast, there was no such survival difference between the KRAS-variant and wild-type groups among patients given chemoimmunotherapy, at a respective 20.0 and 19.3 months.
And for participants with KRAS wild-type disease, median OS was shorter with ICI monotherapy than chemoimmunotherapy, at 13.6 versus 19.3 months, albeit without reaching statistical significance, whereas survival was similar between treatments (21.1 vs 20.0 months) for those harboring KRAS variants.
“Further investigation is needed to optimize selection between multiple available treatment strategies for patients with PD-L1–high NSCLC,” write Charu Aggarwal and colleagues from the University of Pennsylvania in Philadelphia, USA, in JAMA Oncology.
The study included data from the Flatiron Health database on 1127 patients with nonsquamous histology, PD-L1 expression levels of at least 50%, and no known alterations in EGFR, ALK, or ROS1 who received ICI treatment – either alone or alongside chemotherapy – between January 2016 and May 2020.
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