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Hongyun Zhao
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P14 - Immuno-biology and Novel Immunotherapeutics (Phase I and Translational) - Immuno-Biology (ID 153)
- Event: WCLC 2020
- Type: Posters
- Track: Immuno-biology and Novel Immunotherapeutics (Phase I and Translational)
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P14.13 - Notch Family Gene Mutations Predict Clinical Benefit from Immune Checkpoint Inhibitor Therapy in Non-Small Cell Lung Cancer (ID 2224)
00:00 - 00:00 | Author(s): Hongyun Zhao
- Abstract
Introduction
Immune checkpoint inhibitor (ICI) therapy has been a landmark of non-small cell lung cancer (NSCLC) treatment, while the response rate remains to be improved. Notch family gene mutations were reported to be associated with high tumor mutation burden (TMB) in multiple cancer types. In this study, we aimed to evaluate the potential predictive role of Notch mutation in NSCLC ICI treatment.
Methods
Data of NSCLC patients were derived from MSKCC (N=1,567), TCGA (N=1,444), and DFCI (N=56). Notch mutation was defined as any mutation in Notch1, Notch2, Notch3 or Notch4. We compared the overall survival (OS) and progression-free survival (PFS) after ICI treatment between Notch mutation and wild type (WT) subgroups. The efficacy of ICI therapy was evaluated by objective response rate (ORR), disease control rate (DCR) and durable clinical benefit (DCB). The effects of number of mutations and TMB on the predictive effect of Notch mutation were assessed. A combined model of TMB and Notch mutation was also built.
Results
250 (17.36%) of the NSCLC patients had Notch mutation. In the ICI-treated cohort, patients with Notch mutation had longer OS (median OS, 22.00 vs 11.15 months, P = 0.04) (Fig. 1A). PFS of Notch mutant subgroup was longer, but there was no statistically significant difference between groups (median PFS, 9.60 vs 4.27 months, P = 0.08). The ORR, DCR, and DCB in Notch mutant subgroup (36.17%, 61.70% and 44.19%) were higher (Fig. 1B). Patients with two Notch mutations got higher TMB than those with one Notch mutation (median TMB, 30.00 vs 13.00 mut/Mb, P < 0.001). Number of mutations was positively associated with OS after ICI therapy (P = 0.03) (Fig. 1C). TMB of Notch mutant patients was higher (median TMB, 14.00 vs 7.00 mut/Mb, P < 0.001). In both TMB-high and TMB-low patient cohort, no statistically significant difference in OS or PFS was shown between Notch mutant and WT subgroups. In the combined model of Notch mutation and TMB, the difference in OS or PFS between groups was not statistically significant (Fig. 1D). Notch mutation was also a negative prognostic biomarker of NSCLC in non-ICI treated group from MSKCC (median OS, 14.00 vs 37.00 months, P = 0.01).
Conclusion
NSCLC patients with Notch mutation especially those with more Notch mutations get longer OS and better response in ICI treatment, making Notch mutation a positive predictive biomarker. The positive predictive effect of Notch mutation can be associated with TMB.
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P14.14 - PTPRD: A Positive Predictive Biomarker for Immune Checkpoint Blockade Therapy in Non-Small Cell Lung Cancer (ID 2234)
00:00 - 00:00 | Author(s): Hongyun Zhao
- Abstract
Introduction
Immune checkpoint blockade (ICB) therapy has emerged as a promising strategy for non-small cell lung cancer (NSCLC), while issues like low response rate and hyperprogression remain to be solved. Timely identification of predictive biomarkers for ICB therapy is warranted. Purpose of this study was to elucidate the potential predictive effect of Protein tyrosine phosphatase receptor D (PTPRD) mutation in NSCLC ICB therapy.
Methods
We collected a NSCLC cohort of 2767 patients from MSKCC (N=1,567), TCGA (N=1,444), and DFCI (N=56), of which 441 patients were ICB treated. Overall survival (OS) and progression-free survival (PFS) of ICB treated NSCLC patients were compared between PTPRD mutant and wild type (WT) subgroups. Response to ICB treatment was evaluated by objective response rate (ORR), disease control rate (DCR) and durable clinical benefit (DCB). To identify the association between PTPRD mutation and tumor mutation burden (TMB), TMB was compared between groups. Differences in OS between PTPRD mutant and WT subgroups were estimated, with TMB limited as high or low (cut-off data: TMB = 10 mut/Mb). We also built a combined model of PTPRD mutation and TMB in predicting OS after NSCLC ICB therapy.
Results
Prevalence of PTPRD mutation in NSCLC was 12.29%. The OS after ICB treatment was longer in PTPRD mutant subgroup (median OS, not reached [n=49] vs 11 months [n=363], P = 0.01) (Fig. 1A). No difference in PFS after ICB therapy between groups was shown (median PFS, mutant 4.63 vs WT 4.37 months, P = 0.92). PTPRD mutant subgroup had better response to ICB treatment, with ORR, DCR and DCB as 40.00%, 60.00%, and 52.94% respectively (Fig. 1B). PTPRD mutation was associated with higher TMB (median TMB, 19.00 vs 7.00 mut/Mb; P < 0.001). However, among patients with high TMB, PTPRD mutant patients had longer OS than PTPRD WT patients (median OS, not reached vs 12 months, P = 0.06) (Fig. 1C). The differences in OS between groups were still statistically significant, in the combined model of PTPRD mutation and TMB (P = 0.01) (Fig. 1D). Survival trend was not observed in TMB low cohort, because number of PTPRD mutant patients was limited. There was no correlation between PTPRD mutation and OS in non-ICB treated cohort.
Conclusion
PTPRD mutation is a positive predictive biomarker of NSCLC ICB therapy, which may be associated with TMB. Moreover, PTPRD mutation can help identifying patients with larger probability of benefiting from ICB treatment, among patients with high TMB.
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P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- Event: WCLC 2020
- Type: Posters
- Track: Targeted Therapy - Clinically Focused
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P76.38 - Afatinib as a Potential Therapeutic Option for Non-small Cell Lung Cancer Patients with EGFR G724S (ID 1782)
00:00 - 00:00 | Presenting Author(s): Hongyun Zhao
- Abstract
Introduction
EGFR exon 18 G724S mutation has been described to be associated with cancer progression and mediating resistance to first- and third-generation EGFR tyrosine kinase inhibitors(TKIs). In vitro experiments have provided compelling evidence that EGFR G724S retains its sensitivity for second-generation inhibitors, including afatinib. However, limited data has reported the clinical efficacy of afatinib in Non-small cell lung cancer (NSCLC) patients harboring EGFR G724S mutation. In our study, we aimed to investigate the treatment response and survival outcome of advanced lung adenocarcinoma patients with EGFR G724S mutation who were treated with afatinib.
Methods
Eight advanced lung adenocarcinoma patients harboring EGFR G724S mutation were recruited. Afatinib, at a dose of 40 mg once daily, was administered to all these patients. Investigator-assessed objective response and survival outcomes were analyzed. Progression-free survival (PFS) and overall survival (OS) were defined from the start of afatinib therapy until date of progression and date of death or last follow-up, respectively. Acquired resistance mechanisms to afatinib therapy were also described for two patients.
Results
EGFR G724S was identified from 2 patients prior to the administration of any treatment, (baseline) from 1 patient after gefitinib failure and from 5 patients after osimertinib failure. EGFR G724S, either at baseline or acquired during the course of EGFR-TKI treatment, was identified in concurrence with other rare EGFR mutations, including EGFR exon 20 insertion (n=1), EGFR S768I (n=2) and a rare variant of EGFR exon 19 deletion, E746_S752delinsV (19delins; n=5). Interestingly, all the five patients who acquired G724S at osimertinib progression had baseline EGFR exon 19delins. All of these 8 patients achieved stable disease, resulting in a disease control rate (DCR) of 100% with a median PFS of 4.5 months. Analysis of acquired mutations at afatinib progression demonstrates re-emergence of EGFR T790M as a major mechanism of afatinib resistance from two patients with available rebiopsy samples. Patient P4, a female patient with baseline EGFR exon 19delins who progressed from osimertinib after 28.4 months, lost EGFR T790M and acquired G724S at osimertinib progression. After receiving afatinib for 6.1 months, EGFR G724S was undetectable but EGFR T790M re-emerged which mediated her resistance to afatinib. Furthermore, Patient P6, a male patient with baseline EGFR exon 19delins who acquired G724S and lost T790M at osimertinib progression eventually acquired resistance to afatinib within 2.7 months of treatment. He had the re-emergence of T790M and acquisition of EGFR C797S and BRAF V600E while retaining EGFR G724S and 19delins.
Conclusion
Our study provides clinical evidence that afatinib monotherapy could be a potential therapeutic option for NSCLC patients with EGFR G724S. Further studies for evaluating the efficacy of afatinib in advanced NSCLC patients harboring EGFR G724S and the underlying resistance mechanism are warranted.
