Clinical characteristics and outcomes of Chinese patients with KRAS-mutant non-small cell lung cancer after chemotherapy

Dear Editor,The RAS gene is one of the most frequent oncogenes in human cancers,with significantly different mutation frequencies.The RAS family contains three isoforms:KRAS,HRAS and NRAS,with the KRAS mutations being more common than the other two.The KRAS mutation rate varies in non-small cell lung cancer(NSCLC)patients of different races:27%in Caucasians[1]and approximately 10%in Asians[2,3].Recently,the U.S.Food and Drug Administration(FDA)approved sotorasib(AMG510)and adagrasib(MRTX849)for the treatment of metastatic NSCLC harboring KRAS G12C mutations.In the face of novel treatment choices for KRAS-mutated NSCLC,it is indispensable to learn more about the systemic treatment of these patients.Clinical studies have shown that Caucasian patients with KRAS-mutated NSCLC had poor outcomes following first-line chemotherapy[4,5].However,studies on treatment outcomes of Asian patients with KRAS-mutated NSCLC are lacking.As the overwhelming majority of cases are diagnosed with lung adenocarcinoma,the standard first-line treatment for metastatic disease is pemetrexed-based doublet chemotherapy in combination with bevacizumab and/or immunotherapy in China.Herein,we investigated the clinical characteristics of KRAS mutation subtypes,co-occurring genomic alterations,and efficacy of first-line pemetrexed-platinum chemotherapy in Chinese KRAS-mutated NSCLC patients.