Oncogenic drivers (OD) and matched targeted agents (TA): Impact on overall survival in patients with lung adenocarcinoma (LA)?

Background: EGFR tyrosine kinase inhibitors and crizotinib are nowadays the optimal treatment for metastatic LA with activating EGFR mutations and ALK rearrangement, respectively. In addition, several TA are in development for LA with other OD. In France, since 2011, six OD are routinely tested in patients with stage IV LA. The aim of this study was to assess whether systematic detection of OD and matched TA improved overall survival in patients with advanced LA in real-life setting. Methods: This retrospective study included all consecutive patients treated in our department for advanced LA from January 2012 to December 2013. Considered OD were EGFR, ALK, KRAS, HER2, BRAF and PI3KCA. Three groups of patients were studied: first, patients with an OD treated with corresponding TA; second, patients with an OD but not treated with corresponding TA; third, patients without any OD. Results: Among the 261 patients included, 67% were men, 84% were current or former smokers, and 75% had a performance status of 0 to 1. OD alterations were found in 42% of patients: EML4-ALK fusion genes (2%), EGFR (10%), KRAS (26%), BRAF (2%), HER2 (1%), and PI3KCA (1%) mutations. 29 % of patients with OD received matched TA, either as standard of care or in a clinical trial. . Survival data will be presented at the meeting. Conclusion: An actionable OD was routinely detected in nearly half of patients with advanced LA. This systematic detection may influence treatment outcomes, notably with matched TA.