2024 World Conference on Lung Cancer (WCLC) - Posters-P2.11A.05 The Impact of Tumor Molecular Features and Smoking History on Survival with Chemo-Immunotherapy in EGFR-Mutant NSCLC

P2.11A.05 The Impact of Tumor Molecular Features and Smoking History on Survival with Chemo-Immunotherapy in EGFR-Mutant NSCLC

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This study, conducted at Fox Chase Cancer Center, examines how tumor molecular features, smoking history, and co-mutations impact survival outcomes in patients with EGFR-mutant non-small cell lung cancer (NSCLC) treated with chemo-immunotherapy. Using the Flatiron Health-Foundation Medicine clinicogenomic database, researchers analyzed 127 patients treated with pembrolizumab, carboplatin, and pemetrexed.<br /><br />The analysis focused on different EGFR mutations, smoking history, PD-L1 expression, and the presence of TP53 mutations. Results indicated that median real-world progression-free survival (rwPFS) did not significantly differ by EGFR subtype or smoking history. Specifically, the median rwPFS for patients with exon 19 deletion was 5.8 months, while L858R and uncommon variations were 5.4 and 8.4 months, respectively. Differences in median rwPFS between smokers (5.6 months) and non-smokers (6.1 months) were also not significant.<br /><br />PD-L1 expression levels (either 1% or 50%) did not correlate with longer rwPFS. Conversely, the presence of a TP53 co-mutation was a significant predictor of improved rwPFS. Patients with a TP53 mutation demonstrated longer rwPFS (6.6 months) compared to those without the mutation (4.3 months). Multivariable Cox regression analyses confirmed that only TP53 mutations were significantly associated with improved outcomes.<br /><br />The study concludes that standard markers like smoking history, EGFR subtype, or PD-L1 expression do not aid in identifying patients benefiting from chemo-immunotherapy. However, the co-occurrence of a TP53 mutation may predict a more favorable response, suggesting it could serve as a potential biomarker for tailoring treatment in EGFR-driven NSCLC cases. This finding supports further investigations into TP53 co-mutations as an influential factor in treatment planning.

Asset Subtitle

J. Nicholas Bodor

Meta Tag

Speaker J. Nicholas Bodor

Topic Metastatic NSCLC – Immunotherapy

Keywords

EGFR-mutant NSCLC

chemo-immunotherapy

TP53 co-mutation

survival outcomes

Flatiron Health-Foundation Medicine

pembrolizumab

PD-L1 expression

real-world progression-free survival

biomarker

treatment planning