Clinical and Molecular Features of Epidermal Growth Factor Receptor (EGFR) Mutation Positive Non-Small-Cell Lung Cancer (NSCLC) Patients Treated with Tyrosine Kinase Inhibitors (TKIs): Predictive and Prognostic Role of Co-Mutations

Paolo Bironzo; Maria Lucia Reale; Tessa Sperone; Fabrizio Tabbò; Andrea Caglio; Angela Listì; Francesco Passiglia; Massimo Di Maio; Luisella Righi; Federico Bussolino; Giorgio V Scagliotti; Silvia Novello

doi:10.3390/cancers13102425

Clinical and Molecular Features of Epidermal Growth Factor Receptor (EGFR) Mutation Positive Non-Small-Cell Lung Cancer (NSCLC) Patients Treated with Tyrosine Kinase Inhibitors (TKIs): Predictive and Prognostic Role of Co-Mutations

Cancers (Basel). 2021 May 17;13(10):2425. doi: 10.3390/cancers13102425.

Affiliations

¹ Thoracic Oncology Unit, Department of Oncology, San Luigi Gonzaga Hospital, University of Torino, 10043 Orbassano, Italy.
² Medical Oncology Unit, Department of Oncology, Mauriziano Umberto I Hospital, University of Torino, 10128 Torino, Italy.
³ Pathology Unit, Department of Oncology, San Luigi Gonzaga Hospital, University of Torino, 10043 Orbassano, Italy.
⁴ Department of Oncology, University of Torino, 10060 Candiolo, Italy.
⁵ Laboratory of Vascular Oncology, Candiolo Cancer Institute-IRCCS-FPO, 10060 Candiolo, Italy.

Abstract

Background: Tyrosine kinase inhibitors (TKIs) show variable efficacy in epidermal growth factor receptor mutation-positive (EGFR+) NSCLC patients, even in patients harbouring the same mutation. Co-alterations may predict different outcomes to TKIs.

Methods: We retrospectively analysed all consecutive EGFR+ advanced NSCLC treated with first-line TKIs at our Institutions. NGS with a 22 genes clinical panel was performed on diagnostic specimens. PD-L1 expression was also evaluated.

Results: Of the 106 analysed specimens, 59 showed concomitant pathogenic mutations. No differences in OS (mOS 22.8 vs. 29.5 months; p = 0.088), PFS (mPFS 10.9 vs. 11.2 months; p = 0.415) and ORR (55.9% vs. 68.1%; p = 0.202) were observed comparing patients without and with co-alterations. Subgroup analysis by EGFR mutation type and TKIs generation (1st/2nd vs. 3rd) did not show any difference too. No correlations of PD-L1 expression levels by co-mutational status were found. Significant associations with presence of co-alterations and younger age (p = 0.018) and baseline lymph nodes metastases (p = 0.032) were observed. Patients without concomitant alterations had a significant higher risk of bone progression (26.5% vs. 3.3%, p = 0.011).

Conclusions: Pathogenic co-alterations does not seem to predict survival nor efficacy of EGFR TKIs in previously untreated advanced NSCLC.

Keywords: co-mutations; epidermal growth factor receptor (EGFR); next-generation sequencing (NGS); non-small-cell lung cancer (NSCLC); tyrosine kinase inhibitors (TKIs).