Adjuvant immunotherapy in resected non-small cell lung cancer harboring oncogenic driver alterations beyond EGFR and ALK: results from a retrospective analysis.

Authors

Wenxin Jiang, Haiyan Xu, Junling Li, Xuezhi Hao, Linyan Tian, Fang Wei, Weihua Li, Yan Wang

Published in

Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. Jul 26, 2026. Epub Jul 26, 2026.

Abstract

To explore whether adjuvant immunotherapy can improve postoperative prognosis for non-small cell lung cancer (NSCLC) patients harboring oncogenic driver alterations beyond EGFR and ALK, a population with unclear benefit.
Main inclusion criteria included resected NSCLC, stage IB-IIIB, and oncogenic driver alterations of KRAS mutation, ROS1 fusion, RET fusion, HER2 mutation, NTRK fusion, BRAF V600E mutation, and MET exon 14 skipping mutation. The positive PD-L1 cut-off was 1%. Adjuvant immunotherapy would be administered for one year or up to 16 cycles. Disease-free survival (DFS) after surgery was the endpoint.
190 patients with specific gene alterations were included, 25.8% of patients received adjuvant immunotherapy. The benefit from adjuvant immunotherapy in DFS was not observed in the overall population (hazard ratio [HR] 0.85, 95% confidence interval [CI 0.51-1.44, p = 0.551), while a numerical DFS benefit trend in the PD-L1-positive population was observed (HR 0.56, 95% CI 0.31-1.03, p = 0.059). After inverse probability of treatment weighting (IPTW) for the population with PD-L1 positivity who also received adjuvant chemotherapy, no statistical DFS benefit difference from adjuvant immunotherapy was observed between the KRAS (HR 0.29, 95% CI 0.10-0.88, p = 0.028) and non-KRAS mutation (HR 0.77, 95% CI 0.32-1.82, p = 0.549) subgroups (interaction p = 0.179), though with a marked numerical difference. Among the PD-L1-positive population, NSCLC harboring KRAS, MET exon 14 skipping, and BRAF V600E mutations showed a trend toward benefit from adjuvant immunotherapy, whereas NSCLC with HER2 mutation, RET fusion, and ROS1 fusion exhibited a weaker trend toward benefit.
Patients with NSCLC harboring driver oncogenes other than EGFR/ALK and positive PD-L1 showed a trend toward benefiting from adjuvant immunotherapy. Although no significant interaction was observed, KRAS-mutant NSCLC demonstrated numerically superior DFS benefit compared with non-KRAS-mutant NSCLC.

PMID:
42503059
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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