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Tian P, Zeng H, Ji L, Ding Z, Ren L, Gao W, Fan Z, Li L, Le X, Li P, Zhang M, Xia X, Zhang J, Li Y, Li W. Lung adenocarcinoma with ERBB2 exon 20 insertions: Comutations and immunogenomic features related to chemoimmunotherapy. Lung Cancer 2021; 160:50-58. [PMID: 34403912 DOI: 10.1016/j.lungcan.2021.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The genomic mutation and immune feature landscape of ERBB2 exon 20 insertion (ERBB2-ex20ins)-driven non-small cell lung cancer and the features associated with the response to chemoimmunotherapy are currently unknown. METHODS The genomic landscape of ERBB2-ex20ins lung adenocarcinoma (LUAD) patients was characterized by next-generation sequencing (NGS) of 1021 cancer genes. The clinical outcomes of chemoimmunotherapy were evaluated among 13 patients with stage IV ERBB2-ex20ins LUAD, and potential biomarkers of the response to chemoimmunotherapy were explored using NGS and T cell receptor sequencing. RESULTS Among 8247 LUAD patients, 207 (2.5%) had ERBB2-ex20ins, of whom 181 (87.4%) harbored more than one comutation. The most common comutations were in TP53. Patients with ERBB2-ex20ins had a low tumor mutational burden (TMB; median, 4.2 mutations/Mb), and most (66.7%) were PD-L1 negative. Thirteen of the 207 patients received chemoimmunotherapy, for whom the objective response rate, disease control rate, and median progression-free survival were 31%, 77%, and 8.0 months, respectively. Responders exhibited a higher TMB and a trend toward lower clonality in tumors compared with nonresponders (p = 0.0067 and p = 0.085, respectively). A high TMB combined with mutations in DNA damage repair pathways and SWI/SNF chromatin remodeling complexes was associated with a benefit from chemoimmunotherapy. CONCLUSIONS The efficacy and outcome of chemoimmunotherapy were encouraging among ERBB2-ex20ins LUAD patients, who were characterized by low TMB and negative PD-L1 expression. The combination of TMB and comutations is a potential biomarker to identify patients who will benefit from chemoimmunotherapy.
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Affiliation(s)
- Panwen Tian
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liyan Ji
- Geneplus-Beijing, Beijing, China
| | - Zhenyu Ding
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Li Ren
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Gao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zaiwen Fan
- Department of Medical Oncology, Air Force Medical Center. PLA, Beijing, China
| | - Lin Li
- Department of Oncology, Beijing Hospital, Beijing, China
| | - Xiuning Le
- Department of Genomic Medicine and Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | | | | | - Jianjun Zhang
- Department of Genomic Medicine and Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yalun Li
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
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Nong J, Gu Y, Yao S, Zhang Y. Durable response to immunotherapy plus chemotherapy in a patient with untreated, brain-metastatic, EGFR exon 20 insertion mutation lung adenocarcinoma: A case report. Medicine (Baltimore) 2021; 100:e26650. [PMID: 34398022 PMCID: PMC8294870 DOI: 10.1097/md.0000000000026650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
RATIONAL Epidermal growth factor receptor (EGFR) 20 exon insertion is the second most common EGFR aberrations in non-small cell lung cancer (NSCLC). Despite some novel EGFR inhibitors, clinically obtainable management for this subset of patients remains an unmet need. there are no previous reports of upfront combination therapy with immunotherapy and chemotherapy for lung adenocarcinoma with brain metastasis harboring EGFR 20 insertion. PATIENT CONCERNS A 56-year-old man who sought care for dry cough was diagnosed with lung adenocarcinoma with brain metastases indicating a poor prognosis. DIAGNOSIS Next-generation sequencing of lung biopsied tissue revealed an EGFR exon 20 in-frame insertion (P772_H773insYNP+H773Y). INTERVENTIONS The patient started treatment of pemetrexed and carboplatin plus programmed cell death-1 inhibitor sintilimab in November 2019. OUTCOMES The patient achieved partial responses both intra- and extra-cranially. After 6 cycles of treatment, the patient accepted sintilimab plus pemetrexed every 3 weeks as maintenance therapy, which was well-tolerated without any toxicity and is still ongoing after 18 months since initiation of 1st-line treatment. LESSONS This is the first case report of the clinical benefit of upfront immune checkpoint inhibitors (ICIs) plus chemotherapy for a brain metastatic NSCLC patient harboring EGFR exon 20 insertion mutation. Further study is needed to validate the predictor involved in responders to ICIs-based therapy with EGFR mutations.
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Affiliation(s)
- Jingying Nong
- Department of Thoracic Surgery, Xuanwu Hospital, Cancer Center of National Clinical Research Center for Geriatric Diseases, Diagnostic and Treatment Center of Lung Cancer, Capital Medical University, Beijing, China
| | - Yanfei Gu
- Beijing United Family Healthcare Hospital, Beijing, China
| | - Shuyang Yao
- Department of Thoracic Surgery, Xuanwu Hospital, Cancer Center of National Clinical Research Center for Geriatric Diseases, Diagnostic and Treatment Center of Lung Cancer, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Cancer Center of National Clinical Research Center for Geriatric Diseases, Diagnostic and Treatment Center of Lung Cancer, Capital Medical University, Beijing, China
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