LRP1b Loss Predicts Sensitivity to Immunotherapy in Patients with NSCLC: An Analysis of the Phase III CheckMate-026 Randomized Trial.

PURPOSE: Low-density lipoprotein receptor-related protein 1b (LRP1b) is a cell surface receptor, commonly altered in many cancers and associated with improved responses, progression-free survival (PFS), and overall survival with immune checkpoint inhibition. EXPERIMENTAL DESIGN: LRP1b alterations were determined by whole-exome sequencing and associated with PFS and objective response rates in patients with non-small cell lung cancer (NSCLC) in a post hoc analysis of the randomized controlled phase III CheckMate-026 (CM026) trial (NCT02041533) examining chemotherapy compared with nivolumab, adjusting for tumor mutational burden (TMB) and clinical features. We separately evaluated a deidentified nationwide (US-based) NSCLC clinico-genomic database for associations of LRP1b alterations and PFS with anti-PD-1 immunotherapy. RESULTS: In the clinico-genomic database cohort of patients with NSCLC (N = 18,369), LRP1b mutations were positively associated with TP53/KRAS alterations and inversely with EGFR/RET/MET/ERBB2 alterations and significantly improved PFS with PD-1 inhibition (n = 1,569; adjusted HR, 0.86; P = 0.014). In CheckMate-026, patients with LRP1b alterations had a statistically significant improvement in objective response rate to nivolumab versus LRP1b wild-type patients (OR 3.5; 95% confidence interval, 1.71-7.13; P = 0.0006) but not with chemotherapy (OR 0.63; 95% confidence interval, 0.32-1.26; P = 0.19), adjusting for TMB, age, gender, histology, smoking, and performance status. LRP1b mutations were associated with improved PFS with nivolumab (HR, 0.66; P = 0.04) but not chemotherapy (HR, 1.26; P = 0.25), also maintained in multivariate and TMB-adjusted analyses. CONCLUSIONS: LRP1b mutations are a candidate predictive biomarker for immune checkpoint inhibition versus chemotherapy in NSCLC. Further mechanistic characterization of LRP1b and prospective validation are warranted and might enable future clinical use.

Duke Scholars

Author Andrew John Armstrong Medicine, Medical Oncology

Author Neal Edward Ready Medicine, Medical Oncology