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The role of immunotherapy for patients with rare mutations

Data are mounting regarding rare mutations such as MET (exon 14 skipping mutation and MET amplification), ROS1 translocation and rare EGFR mutations and response to targeted therapy,. Simultaneously data are increasing concerning treatment of NSCLC patients with immune check point inhibitors. As yet, the role of immunotherapy in patients with rare genomic alterations has not been determined. Finkel I and Peled N (abstract P2.07-048) described a case series of patients who can benefit from both therapies and summarizes their response for each treatment.

Result

Two males and two females (mean age 58) were included in this retrospective analysis. Three of them were diagnosed with Adenocarcinoma and the remaining one was diagnosed with squamous cell carcinoma. Each patient was diagnosed with a specific gene alteration (C-met exon 14 skipping mutation, EGFR Q861L, MET amplification and ROS1 translocation). Patients underwent targeted therapy as well as immunotherapy. Two patients had PD-L1 staining > 50 %. One patient demonstrated an early and durable complete response with immune check point inhibitors, one patient had progressed on immunotherapy quickly but respond well to targeted therapy, two patients responded as expected to targeted therapy and got immune check point inhibitors as a second line and still being treated with good response.

Conclusion

The role of immunotherapy for patients with uncommon EGFR mutations, ROS1 and C-MET who express PD-L1 is still unclear. Further studies in this unique population are needed.

Reference:
Finkel I, Peled N, abstract P2.07-048: Immunotherapy vs. Targeted Therapy – Who Wins? A Case Series

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