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Stratmann JA, Althoff FC, Doebel P, Rauh J, Trummer A, Hünerlitürkoglu AN, Frost N, Yildirim H, Christopoulos P, Burkhard O, Büschenfelde CMZ, Becker von Rose A, Alt J, Aries SP, Webendörfer M, Kaldune S, Uhlenbruch M, Tritchkova G, Waller CF, Rittmeyer A, Hoffknecht P, Braess J, Kopp HG, Grohé C, Schäfer M, Schumann C, Griesinger F, Kuon J, Sebastian M, Reinmuth N. Sotorasib in KRAS G12C-mutated non-small cell lung cancer: A multicenter real-world experience from the compassionate use program in Germany. Eur J Cancer 2024; 201:113911. [PMID: 38377774 DOI: 10.1016/j.ejca.2024.113911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Sotorasib is a first-in-class KRAS p.G12C-inhibitor that has entered clinical trials in pretreated patients with non-small cell lung cancer (NSCLC) in 2018. First response rates were promising in the CodeBreaK trials. It remains unclear whether response to sotorasib and outcomes differ in a real-world setting when including patients underrepresented in clinical trials. METHODS Patients with KRAS p.G12C-mutated advanced or metastatic NSCLC received sotorasib within the German multicenter sotorasib compassionate use program between 2020 to 2022. Data on efficacy, tolerability, and survival were analyzed in the full cohort and in subgroups of special interest such as co-occurring mutations and across PD-L1 expression levels. RESULTS We analyzed 163 patients who received sotorasib after a median of two treatment lines (range, 0 to 7). Every fourth patient had a poor performance status and 38% had brain metastases (BM). The objective response rate was 38.7%. The median overall survival was 9.8 months (95% CI, 6.5 to not reached). Median real-world (rw) progression-free survival was 4.8 months (9% CI, 3.9 to 5.9). Dose reductions and permanent discontinuation were necessary in 35 (21.5%) and 7 (4.3%) patients, respectively. Efficacy seems to be influenced by PD-L1 expression and a co-occurring KEAP1 mutation. KEAP1 was associated with an inferior survival. Other factors such as BM, STK11, and TP53 mutations had no impact on response and survival. CONCLUSION First results from a real-world population confirm promising efficacy of sotorasib for the treatment of advanced KRAS p.G12C-mutated NSCLC. Patients with co-occurring KEAP1 mutations seem to derive less benefit.
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Affiliation(s)
- Jan A Stratmann
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
| | - Friederike C Althoff
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany.
| | - Paula Doebel
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
| | - Jacqueline Rauh
- Hospital Witten, Medical Specialist Center of Internal Medicine, Witten, Germany
| | - Arne Trummer
- Municipal Clinic Braunschweig, Medical Specialist Center of Hematology/Oncology, Braunschweig, Germany
| | | | - Nikolaj Frost
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | | | - Petros Christopoulos
- University Hospital Heidelberg, Thoraxklinik Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, member of the German Center for Lung Research (DZL), Germany
| | - Oswald Burkhard
- Medical Specialist Center of Internal Medicine, Hematology Oncology, Palliative Medicine in Worms, Worms, Germany
| | | | - Aaron Becker von Rose
- Technical University Munich, Klinikum rechts der Isar, Medical Department for Haematology and Oncology, Munich, Germany
| | - Jürgen Alt
- University Medical Center Mainz, Department of Internal Medicine III, Mainz, Germany
| | | | - Maximilian Webendörfer
- University Hospital Essen, West German Cancer Center, Department of Medical Oncology, Essen, Germany
| | - Stefan Kaldune
- RoMed Clinic Rosenheim, Department of Hematology/Oncology, Rosenheim, Germany
| | - Mark Uhlenbruch
- Kaiserswerther Diakonie Florence-Nightingale-Hospital Düsseldorf, Department of Hematology/Oncology, Düsseldorf, Germany
| | - Guergana Tritchkova
- University Hospital Dresden, TU Dresden, Clinic for Internal Medicine I, Dresden, Germany
| | - Cornelius F Waller
- University of Freiburg, University Medical Centre Freiburg, Department of Haematology, Oncology and Stem Cell Transplantation, Freiburg, Germany
| | | | - Petra Hoffknecht
- Niels-Stensen-Kliniken Franziskus Hospital Harderberg, Department of Hematology/Oncology, Hardenberg, Germany
| | - Jan Braess
- Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Hans-Georg Kopp
- Robert Bosch Center for Tumor Diseases, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Monica Schäfer
- Helios Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - Christian Schumann
- Klinikverbund Allgäu gGmbH, Clinic for Pneumology, Thoracic Oncology, Sleep and Respiratory Medicine, Kempten and Immenstadt, Germany
| | - Frank Griesinger
- Pius-Hospital, University Medicine Oldenburg, Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Oldenburg, Germany
| | - Jonas Kuon
- Lungenklinik Löwenstein, Department of Oncology, Löwenstein, Germany
| | - Martin Sebastian
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
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