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Background Immune checkpoint inhibitors have shown limited clinical benefits in MSS-CRC; dual targeting of non-redundant pathways may enhance antitumor immune response. In a phase I/II, multicenter, open-label study, the anti-PD-L1 antibody durvalumab (D) was combined with monalizumab (M), an IgG4 mAb that blocks NKG2A binding to HLA-E to reduce inhibition of NK and CD8+ T cells. The combination (D+M) was well tolerated and showed encouraging activity in heavily pretreated pts with advanced MSS-CRC. In a dose-exploration cohort, D+M was assessed in combination with standard of care (SOC) chemotherapy and bevacizumab, an anti-VEGF agent, as first-line therapy for advanced/metastatic MSS-CRC. Methods Eligible pts had histologically defined MSS-CRC, regardless of RAS/RAF mutational status, ECOG 0–1 and no prior systemic therapy. They received durvalumab 1500mg Q4W, monalizumab 750mg Q2W, modified FOLFOX6 (folinic acid, fluorouracil, and oxaliplatin) Q2W and bevacizumab 5mg/kg Q2W until end of treatment; dose modifications were allowed according to SOC practice except during the DLT evaluation period. The primary endpoint was safety and tolerability of D+M with FOLFOX6 and bevacizumab; secondary endpoints included antitumor activity. Results As of Mar 25, 2019, 18 pts were enrolled with median follow-up of 6.2 months. Monalizumab-related adverse events (AEs) occurred in 13 (72%), serious in 1 (6%; embolism). Durvalumab-related AEs occurred in 14 (78%; none serious). All pts had chemotherapy-related AEs, serious in 1 (6%; febrile neutropenia) and 10 (56%) had bevacizumab-related AEs, serious in 2 (11%; embolism and febrile neutropenia). There were no grade 5 or dose-limiting toxicities. At 16 weeks, 17 pts were evaluable for response; 9 (53%) had partial responses (7 confirmed, 2 unconfirmed), 6 (35%) had stable disease and 2 (12%) had progressive disease; there were no complete responses. Median time to response for the 7 confirmed responders was 15.4 weeks; median duration of response was not yet reached. Conclusions First-line D+M combined with SOC showed manageable safety and preliminary activity in pts with advanced/metastatic MSS-CRC. Accrual is complete. Clinical trial identification NCT02671435. Editorial acknowledgement Medical writing support was provided by Hashem Dbouk, PhD, of Cirrus Communications (Lyndhurst, NJ), an Ashfield company, and was funded by AstraZeneca. Legal entity responsible for the study AstraZeneca. Funding AstraZeneca. Disclosure J.C. Bendell: Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Gilead; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Genentech/Roche; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Advisory / Consultancy, Research grant / Funding (institution): Five Prime; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Lilly; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Merck; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Celgene; Research grant / Funding (institution): EMD Serono; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Taiho; Advisory / Consultancy, Research grant / Funding (institution): MacroGenics; Advisory / Consultancy, Research grant / Funding (institution): GSK; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Novartis; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: OncoMed; Advisory / Consultancy, Research grant / Funding (institution): LEAP; Advisory / Consultancy, Research grant / Funding (institution): TG Therapeutics; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: BI; Advisory / Consultancy, Research grant / Funding (institution): Daiichi Sankyo; Advisory / Consultancy, Research grant / Funding (institution): Bayer; Advisory / Consultancy, Research grant / Funding (institution): Incyte; Advisory / Consultancy, Research grant / Funding (institution): Apexigen; Research grant / Funding (institution): Koltan; Research grant / Funding (institution): SynDevRex; Research grant / Funding (institution): Forty Seven; Research grant / Funding (institution): AbbVie; Advisory / Consultancy, Research grant / Funding (institution): Array; Research grant / Funding (institution): Onyx; Advisory / Consultancy, Research grant / Funding (institution): Sanofi; Research grant / Funding (institution): Takeda; Research grant / Funding (institution): Eisai; Research grant / Funding (institution): Celldex; Advisory / Consultancy, Research grant / Funding (institution): Agios; Research grant / Funding (institution): Cytomx; Research grant / Funding (institution): Nektar; Research grant / Funding (institution), Travel / Accommodation / Expenses: ARMO; Research grant / Funding (institution): Boston Biomedical; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Ipsen; Advisory / Consultancy, Research grant / Funding (institution): Merrimack; Research grant / Funding (institution): Tarveda; Research grant / Funding (institution): Tyrogenex; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Oncogenex; Research grant / Funding (institution): Marshall Edwards; Research grant / Funding (institution): Pieris; Research grant / Funding (institution): Mersana; Research grant / Funding (institution): Calithera; Research grant / Funding (institution): Blueprint; Research grant / Funding (institution): Evelo; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Forma; Research grant / Funding (institution): Merus; Research grant / Funding (institution): Jacobio; Research grant / Funding (institution): Effector; Research grant / Funding (institution): Novocare; Research grant / Funding (institution): Arrys; Research grant / Funding (institution): Tracon; Research grant / Funding (institution): Sierra; Advisory / Consultancy, Research grant / Funding (institution): Innate; Advisory / Consultancy, Research grant / Funding (institution): Arch Oncology; Advisory / Consultancy, Research grant / Funding (institution): Prelude Oncology; Research grant / Funding (institution): Unum Therapeutics; Research grant / Funding (institution): Vyriad; Research grant / Funding (institution): Harpoon; Research grant / Funding (institution): ADC; Advisory / Consultancy, Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Millennium; Research grant / Funding (institution): Imclone; Research grant / Funding (institution): Acerta Pharma; Research grant / Funding (institution): Rgenix; Research grant / Funding (institution): Bellicum; Advisory / Consultancy: Phoenix Bio; Advisory / Consultancy: Cyteir; Advisory / Consultancy: Molecular Partners; Advisory / Consultancy: Innate; Advisory / Consultancy: Torque; Advisory / Consultancy: Tizona; Advisory / Consultancy: Janssen; Advisory / Consultancy: Tolero; Advisory / Consultancy: TD2 (Translational Drug Development); Advisory / Consultancy: Seattle Genetics; Advisory / Consultancy: Moderna Therapeutics; Advisory / Consultancy: Tanabe Research Laboratories; Advisory / Consultancy: Beigene; Advisory / Consultancy: Continuum Clinical; Advisory / Consultancy: Kyn. J. Naidoo: Research grant / Funding (institution): Merck; Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy: BMS. X. Li: Full / Part-time employment: AstraZeneca. P. Kourtesis: Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. S.E. Abdullah: Travel / Accommodation / Expenses, Shareholder / Stockholder / Stock options, Full / Part-time employment: AstraZeneca. S. Patel: Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Bristol-Myers Squibb; Advisory / Consultancy: Illumina; Advisory / Consultancy: Nektar; Advisory / Consultancy: Tempus; Research grant / Funding (institution): Eli Lilly; Research grant / Funding (institution): Fate; Research grant / Funding (institution): Incyte; Research grant / Funding (institution): Merck; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche/Genentech; Research grant / Funding (institution): Xcovery; Research grant / Funding (institution): Fate Therapeutics; Research grant / Funding (institution): Genocea; Research grant / Funding (institution): Iovance. All other authors have declared no conflicts of interest.

Aim: LCNEC is a rare thoracic malignancy, for which pathologic classification and optimal therapies are debated. We report the largest series of stage IV LCNECs, evaluating clinicopathologic features, treatment and survival. Methods: Pts with stage IV LCNEC evaluated at MSKCC from 2006-2013 were identified. Clinicopathologic and treatment data were collected. Radiologic RECIST evaluation was performed for pts with existing diagnostic imaging. Pts with available tissue underwent pathology re-review to confirm diagnosis, and potentially identify features that could impact outcomes. Results: 50 pts were identified (median age: 66 years; 62% male; 88% former/current smokers). Common sites of metastasis: lymph nodes (n = 29); brain (n = 22); liver (n = 13). 34% of pts had diagnostic molecular testing with PCR-based fragment length analysis, mass spectrometry based assay for point mutation genotyping, and ALK FISH testing: 24% had KRAS mutations (mtns) (n = 4/17; G12D, n = 2; G12C, n = 1; Q61H, n = 1). No EGFR mtns or ALK rearrangements were noted. 33 pts had archived tumor at MSKCC for central pathology re-review. The diagnosis of LCNEC was confirmed in all but 2 cases, which were reclassified as SCLC and combined SCLC/LCNEC (both brain metastases), respectively. Treatment data was available on 39 pts: 77% (n = 30) received first-line platinum(plt)/etoposide. 23% (n = 9) received other regimens: plt/taxane (n = 4), plt/pemetrexed (n = 1), plt/pemetrexed/bevacizumab(bev) (n = 1), temozolomide (n = 1)/bev (n = 1), clinical trial (n = 1). Objective response rate was 32% with plt/etoposide by RECIST (95% CI: 16-52%). Median OS was 12.2mos (range: 9-19.3mos) for all pts. Karnofsky performance status 250 were poor prognostic factors for OS on multivariate analysis (p Conclusions: Pts with stage IV LCNEC have low response to plt/etoposide treatment and poor OS. KRAS mutations are commonly observed. Prospective studies are needed to investigate optimum therapeutic strategies. Disclosure: All authors have declared no conflicts of interest.