Demographic and genomic landscape of early mortality in patients with stage IV non–small-cell lung cancer.

Abstract

11054 Background: Early mortality presents an ongoing challenge to oncologists all over the world. Specifically, one-third of patients that present with late-stage lung cancer progress rapidly, succumbing to their disease before treatment is initiated. That is why stratification of high-risk patients is imperative. In this study, we describe the epidemiologic and genomic landscape of early mortality in Stage IV non-small cell lung cancer (NSCLC). Methods: We retrospectively analyzed clinical and genetic data from the AACR Genie NSCLC v2.0 cohort via cBioPortal. Patients with Stage IV NSCLC who died within 3 months of their sequencing sample collection were classified as early mortality and compared to patients who survived more than 3 months. The chi-squared test was used to assess statistical association between variables. A p value or a q value of < 0.05 was considered significant. Results: A total of 871 patients were retrieved; 66 patients died within the first 3 months of diagnosis. Patients in the early mortality group were older (68.1 vs 64.1, p < 0.05). No significant difference in sex, stage, and histology was present. Patients who died earlier had more brain, adrenal, and subcutaneous metastasis (P < 0.05). Notably, patients in the early mortality group had a higher prevalence of current smokers as compared to a higher prevalence of never smokers in the other group, with a statistically significant difference in overall smoking rates between both groups (p < 0.05). A total of 18/66 (27.3%) patients received any form of treatment in the early mortality group, 3 of whom received PD-1 or CTLA4 ICI’s. In terms of genomic alterations, patients who died early had a higher frequency of KRAS (56.1% vs. 27.0%, q < 0.05) and STK11 (38.6% vs 11.2%, q < 0.05). On the other hand, those who did not die early had a higher frequency of EGFR mutations (32.3% vs 6.10%, q < 0.05). KEAP1 alteration was higher in the early mortality group but did not achieve statistical significance (31.8% vs 11.5%, q = 0.095). Conclusions: Patients who are older, current smokers, and possess KRAS or STK11 mutations were more likely to die within 3 months of diagnosis. These results are in line with the literature and are known to be strong predictors of mortality in NSCLC patients and should be incorporated in the initial evaluation of Lung cancer patients.