Efficacy of first-line chemotherapy combined with immunotherapy or anti-angiogenic therapy in advanced KRAS-mutant non-small cell lung cancer

作者：Huiping Qiang, Yue Wang, Yao Zhang, Jingwen Li, Lincheng Zhang, Huawei Du, Xuxinyi Ling, Shuhui Cao, Yan Zhou, Runbo Zhong, Hua Zhong · 发表于：Translational Oncology · 年份：2025 · DOI：10.1016/j.tranon.2025.102317 · 被引用次数：9 · 研究领域：Lung Cancer Treatments and Mutations、Cancer Immunotherapy and Biomarkers、Melanoma and MAPK Pathways

• Anti-PD-1/PD-L1 immunotherapy has brought significant survival benefit to advanced KRAS-mutant NSCLC patients. • For advanced KRAS-mutant NSCLC patients, first-line immunotherapy combined with chemotherapy have a better response than first-line chemotherapy combined with anti-angiogenic therapy. • Positive PD-L1 expression may be predictive factor for prolonging the survival of first-line immunotherapy combined with chemotherapy. Approximately 30 % non-small cell lung cancer (NSCLC) patients carry KRAS mutations in western countries. First-line chemotherapy combined with immunotherapy has been the standard therapeutic regimen for KRAS -mutant NSCLC patients. This population could also benefit from chemotherapy combined with anti-angiogenic therapy. However, few studies has reported on head-to-head efficacy comparisons between these two treatment strategies. We selected stage IV KRAS -mutated NSCLC patients diagnosed from 2017 to 2022. Their clinical baseline characteristics, first-line treatment strategy, whether combined TP53 or STK11 mutation, PD-L1 expression level, etc. were evaluated. The correlation between these factors and progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 273 patients received first-line systematic therapy. The most common mutation was KRAS G12C (34.3 %). First-line chemotherapy combined with immunotherapy brought significant survival benefits (mPFS: 11.0 months vs. 4.0 months, P = 0.0003; mOS: 17.0 months vs. 9.0 m...