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CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(02): 127-133
DOI: 10.1055/s-0043-1775800
Original Article

The Effect of Chemotherapeutic Agents on Survival in Metastatic Non-Small-Cell Lung Cancer with KRAS Mutation

Mustafa Emre Duygulu 
1   Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
,
Atila Yildirim
1   Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
,
Eyyup Ayas
1   Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
,
Nese Alyildiz
1   Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
,
Sevdegul Aydin Mungan
2   Department of Pathology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
,
Evren Fidan
1   Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
› Author Affiliations Funding None declared.
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Abstract

Introduction KRAS mutation is observed in up to 30% of non-small-cell lung cancer (NSCLC) cases and is corelated with a poor prognosis. In the cases with KRAS p.G12C mutation and first-line chemotherapy (± immunotherapy) resistance, a targeted drug option is available.

Objectives Our study aimed to examine the correlation between first-line chemotherapy agents and treatment response in patients with KRAS-mutated metastatic NSCLC.

Materials and Methods Retrospective database searches were performed on cases diagnosed with metastatic NSCLC at our center between January 2019 and December 2021 that were found to be KRAS mutation positive using the next-generation sequencing (NGS) approach. The cases were classified into five subgroups based on the chemotherapy regimens (platinum + gemcitabine, platinum + taxane, platinum + pemetrexed, platinum + vinorelbine, and others). The clinical and demographic data of 41 cases were analyzed retrospectively, and survival analyses were performed using the Kaplan–Meier method.

Results Thirty-seven of 41 patients (90.2%) were males, and 27 (65.9%) had adenocarcinoma histology. The most prevalent mutation was KRAS G12C, with 12 cases (29.2%), followed by KRAS G12V, with 9 cases (21.9%). Other mutations were as follows: KRAS G12D 4 (9%), KRAS G13C 3 (7.3%), KRAS G12A 2 (4.8%), KRAS G12R 2 (4.8%), KRAS Q61H 2 (4.8%), KRAS Q61L 2 (4.8%), KRAS V14I 2 (4.8%), KRAS A146T 1 (2.4%), KRAS G13G 1 (2.4%), and KRAS G1C 1 (2.4%). The median progression-free survival (mPFS) for all groups was 4.6 months (95% confidence interval [CI]: 2.7-6.5), and there were no statistically significant differences between the groups (p = 0.121). The median overall survival (mOS) for all groups was 9.3 months (95% CI: 3.8–14.5), and there were no statistically significant differences between the groups (p = 0.805).

Conclusions OS and PFS analyses showed no differences between platinum + taxane, platin + pemetrexed, platinum + gemcitabine, and platin + vinorelbine used in first-line treatments for KRAS mutant NSCLC cases. We believe that patient-specific characteristics may be a determining factor in selecting chemotherapy for this patient population.

Keywords

metastatic NSCLC - KRAS - chemotherapy - OS - PFS - platinum

Author Contributions

Mustafa Emre Duygulu was responsible for design, statistical analysis, and manuscript preparation. Data analysis was done by Atila Yildirim. Literature search was conducted by Eyyup Ayas. Data acquisition was done by Nese Alyildiz. Definition of intellectual content was provided by Sevdegul Aydin Mungan. Manuscript editing and manuscript review were done by Evren Fidan. All the authors read and approved the final version of the manuscript.


Patient Consent

None declared.




Publication History

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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