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PS02.18 Characterization of Patients with KRAS-Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) in a Community Practice Setting
November 2017 preferred first-line treatment for patients with EGFR, ALK, ROS1, BRAF and MET alterations regardless of TPS. Patients with RET and HER2 alterations were treated similarly to those with nonsquamous disease and no targetable mutation — for a TPS of 10% chemotherapy was given by all investigators, with about one third adding pembrolizumab. For a TPS of 60% pembrolizumab alone was used by 92% of investigators. For patients with EGFR mutations and response followed by progression on an up-front TKI, all investigators test for T790M mutations, with 72% preferring a plasma assay followed by tissue testing if negative. All investigators use osimertinib in T790M-positive recurrent tumors regardless of TPS. For patients with T790M-negative tumors and a TPS of 10% chemotherapy is used by 84% and chemotherapy with a CI by 8%. With a TPS of 60% chemotherapy is used by 64% and chemotherapy with a CI by 24%.
Poster Sessions
S1571
Background: No targeted therapy is currently approved for KRASmutant NSCLC despite being the most common molecular-defined subset of NSCLC, and data are limited in real-world populations. The purpose of this study is to understand the demographic, pathologic, and clinical characteristics associated with KRAS testing and mutations among patients with NSCLC. Methods: This retrospective study using the Flatiron Health NSCLC cohort included community practice patients diagnosed with de novo or recurrent advanced NSCLC from 1 Jan 2011 to 31 Dec 2016. Patients were divided into KRAS tested and not tested groups, the former being further divided into KRAS mutated (KRASm+) and KRAS wild-type (KRASwt). PD-L1 status was abstracted exactly as stated in the test report; no additional interpretation based on staining percentage was applied by the data abstractor. Descriptive analyses were conducted and association between KRAS mutation and OS was evaluated by a multivariate Cox model. Results: Of 29,903 patients meeting study criteria, 5588 (19%) were tested for KRAS mutations. KRAS testing was more commonly conducted in patients who were female (21% vs 17% for males, P<0.001), had non-squamous histology (23% vs 8% for squamous and 13% for NOS, P<0.001), and were <55 years (22% vs 21% for 55-65 years, and 17% for >65 years, P<0.001). Race, region, performance score and practice volume also had a significant effect on whether KRAS was tested. Non-smokers were more likely to be tested than smokers, regardless of sex (29% vs 19% in females P<0.001; 26% vs 16% in males, P<0.001). Over half (53%) of tested patients were tested prior to starting first-line therapy. Of patients tested for EGFR, ALK, ROS, and PD-L1, 97%, 92%, 58% and 21%, respectively, had KRAS tested concurrently. Patients with KRASm+ (n¼1602, 29%) were more likely to have smoking history (90% vs 76%, P<0.001) and non-squamous histology (92% vs 82%, P<0.001) than patients with KRASwt. The prevalence of KRASm+ was 31%, 23%, and 13% for White, African-American/Black, and Asian patients, respectively. Prevalence of overlap mutations included: KRAS with EGFR 2.5%, ALK 0.5%, ROS 0.4%, and PD-L1 39.9%. Among treated patients, KRASm+ was a negative prognostic factor for OS from the start of first-line therapy (adjusted HR 1.24; 95% CI 1.13, 1.36). Conclusion: Our findings add to current knowledge by describing the adoption of KRAS testing and characteristics of KRASm+ patients in a community setting, particularly with respect to overlap of PD-L1 and KRAS and the prognostic significance of KRAS mutations.
PS02.19 Systematic Literature Review to Assess Role of KRAS Mutations as Prognostic Factors/Treatment Effect Modifiers in Advanced/Metastatic in NSCLC Topic: Medical Oncology Conclusion: Characteristic practice patterns were observed in lung cancer investigators’ selection and sequencing of targeted therapy, immunotherapy and chemotherapy for 22 broad clinical subtypes of mNSCLC defined by histology, mutation status and TPS. This information will be incorporated into several educational tools for clinicians.
PS02.18 Characterization of Patients with KRAS-Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) in a Community Practice Setting Topic: Medical Oncology L. Zhang,1 G. Cuyun Carter,1 J. Beyrer,1 L. Li,1 K. Sheffield,1 C. Muehlenbein,1 M. Boye,1 C. Molife,1 K. Frantz,1 W. John,1 S.M. Gadgeel2 1Eli Lilly and Company, Indianapolis, IN/US, 2University of Michigan, Ann Arbor, MI/US
R.E. Goulding,1 G. Cuyun Carter,2 A. Rojubally,1 M. Boye,2 K. Sheffield,2 W. John,2 C. Muehlenbein,2 L. Li,2 M. Jen,3 J. Jansen,1 E. Druyts1 1Precision Health Economics, Vancouver, BC/CA, 2Eli Lilly and Company, Indianapolis, IN/US, 3Eli Lilly, Indianapolis, IN/US Background: Tumors associated with KRAS mutations are found in approximately 25% of patients with lung adenocarcinoma. There are no approved targeted therapies for KRAS-mutant lung cancer. The purpose of this project was to conduct an SLR for identification of studies investigating the role of KRAS mutation status as a prognostic factor and/or treatment effect modifier of survival and response outcomes in patients with advanced/metastatic (stage IIIB-IV) NSCLC. Methods: Relevant studies were identified by searching MEDLINE, EMBASE, and CENTRAL via Ovid. Two independent reviewers assessed and extracted data for all abstract and full-text selections using predefined selection criteria. Discrepancies were reconciled by a third investigator. In addition, a hand-search of relevant conference proceedings and ClinicalTrials.gov was conducted. Results: To investigate the role of KRAS as a prognostic factor and/or treatment effect
Poster Sessions
S1571
Background: No targeted therapy is currently approved for KRASmutant NSCLC despite being the most common molecular-defined subset of NSCLC, and data are limited in real-world populations. The purpose of this study is to understand the demographic, pathologic, and clinical characteristics associated with KRAS testing and mutations among patients with NSCLC. Methods: This retrospective study using the Flatiron Health NSCLC cohort included community practice patients diagnosed with de novo or recurrent advanced NSCLC from 1 Jan 2011 to 31 Dec 2016. Patients were divided into KRAS tested and not tested groups, the former being further divided into KRAS mutated (KRASm+) and KRAS wild-type (KRASwt). PD-L1 status was abstracted exactly as stated in the test report; no additional interpretation based on staining percentage was applied by the data abstractor. Descriptive analyses were conducted and association between KRAS mutation and OS was evaluated by a multivariate Cox model. Results: Of 29,903 patients meeting study criteria, 5588 (19%) were tested for KRAS mutations. KRAS testing was more commonly conducted in patients who were female (21% vs 17% for males, P<0.001), had non-squamous histology (23% vs 8% for squamous and 13% for NOS, P<0.001), and were <55 years (22% vs 21% for 55-65 years, and 17% for >65 years, P<0.001). Race, region, performance score and practice volume also had a significant effect on whether KRAS was tested. Non-smokers were more likely to be tested than smokers, regardless of sex (29% vs 19% in females P<0.001; 26% vs 16% in males, P<0.001). Over half (53%) of tested patients were tested prior to starting first-line therapy. Of patients tested for EGFR, ALK, ROS, and PD-L1, 97%, 92%, 58% and 21%, respectively, had KRAS tested concurrently. Patients with KRASm+ (n¼1602, 29%) were more likely to have smoking history (90% vs 76%, P<0.001) and non-squamous histology (92% vs 82%, P<0.001) than patients with KRASwt. The prevalence of KRASm+ was 31%, 23%, and 13% for White, African-American/Black, and Asian patients, respectively. Prevalence of overlap mutations included: KRAS with EGFR 2.5%, ALK 0.5%, ROS 0.4%, and PD-L1 39.9%. Among treated patients, KRASm+ was a negative prognostic factor for OS from the start of first-line therapy (adjusted HR 1.24; 95% CI 1.13, 1.36). Conclusion: Our findings add to current knowledge by describing the adoption of KRAS testing and characteristics of KRASm+ patients in a community setting, particularly with respect to overlap of PD-L1 and KRAS and the prognostic significance of KRAS mutations.
PS02.19 Systematic Literature Review to Assess Role of KRAS Mutations as Prognostic Factors/Treatment Effect Modifiers in Advanced/Metastatic in NSCLC Topic: Medical Oncology Conclusion: Characteristic practice patterns were observed in lung cancer investigators’ selection and sequencing of targeted therapy, immunotherapy and chemotherapy for 22 broad clinical subtypes of mNSCLC defined by histology, mutation status and TPS. This information will be incorporated into several educational tools for clinicians.
PS02.18 Characterization of Patients with KRAS-Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) in a Community Practice Setting Topic: Medical Oncology L. Zhang,1 G. Cuyun Carter,1 J. Beyrer,1 L. Li,1 K. Sheffield,1 C. Muehlenbein,1 M. Boye,1 C. Molife,1 K. Frantz,1 W. John,1 S.M. Gadgeel2 1Eli Lilly and Company, Indianapolis, IN/US, 2University of Michigan, Ann Arbor, MI/US
R.E. Goulding,1 G. Cuyun Carter,2 A. Rojubally,1 M. Boye,2 K. Sheffield,2 W. John,2 C. Muehlenbein,2 L. Li,2 M. Jen,3 J. Jansen,1 E. Druyts1 1Precision Health Economics, Vancouver, BC/CA, 2Eli Lilly and Company, Indianapolis, IN/US, 3Eli Lilly, Indianapolis, IN/US Background: Tumors associated with KRAS mutations are found in approximately 25% of patients with lung adenocarcinoma. There are no approved targeted therapies for KRAS-mutant lung cancer. The purpose of this project was to conduct an SLR for identification of studies investigating the role of KRAS mutation status as a prognostic factor and/or treatment effect modifier of survival and response outcomes in patients with advanced/metastatic (stage IIIB-IV) NSCLC. Methods: Relevant studies were identified by searching MEDLINE, EMBASE, and CENTRAL via Ovid. Two independent reviewers assessed and extracted data for all abstract and full-text selections using predefined selection criteria. Discrepancies were reconciled by a third investigator. In addition, a hand-search of relevant conference proceedings and ClinicalTrials.gov was conducted. Results: To investigate the role of KRAS as a prognostic factor and/or treatment effect