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Background: The role of activating alterations in the MAPK pathway in predicting immunotherapy efficacy in lung squamous cell carcinoma (LSCC) patients is largely unknown. The aims of the randomized, phase II SQUINT trial were to assess the efficacy of nivolumab plus ipilimumab (NI) versus platinum-based chemotherapy plus nivolumab (N-CT) and to identify clinically available biomarkers of response to immunotherapy in patients with advanced or metastatic LSCC., Methods: SQUINT was an open-label, randomized, parallel, non-comparative, phase II trial of NI versus N-CT in chemo-naïve, metastatic or recurrent LSCC adult patients. The study was conducted across 15 Italian centers from September 2017 to February 2022 (ClinicalTrials.gov ID: NCT03823625)., Results: 45 patients were included in the NI arm and 46 in the N-CT arm. At 12 months, the overall survival (OS) rate was 62% in the NI arm and 50% in the N-CT arm. 74 patients were included in the analyses for individual biomarkers. In patients with mutations or copy number variations of genes involved in the MAPK pathway, we observed higher response to immunotherapy (43% vs 15%), longer progression-free survival (PFS) (p=0.03) and OS (p<0.001). A higher density of CD8+PD1+ T cells (p=0.04) among MAPK-altered tumors versus wild-type, together with an increased CD8+PD1+/FOXP3 ratio (p=0.047) were observed. In the validation cohort of patients not exposed to immunotherapy, OS was similar between MAPK13 mutant and wild-type LSCC., Conclusion: We showed for the first time that MAPK pathway activating alteration influences the outcome of LSCC treated with immunotherapy, highlighting the relevance of gene profiling.

Purpose: MET -deregulated NSCLC represents an urgent clinical need because of unfavorable prognosis and lack of specific therapies. Although recent studies have suggested a potential role for crizotinib in patients harboring MET amplification or exon 14 mutations, no conclusive data are currently available. This study aimed at investigating activity of crizotinib in patients harboring MET or ROS1 alterations., Patients and Methods: Patients with pretreated advanced NSCLC and evidence of ROS1 rearrangements (cohort A) or MET deregulation (amplification, ratio MET/CEP7 >2.2 or MET exon 14 mutations, cohort B) were treated with crizotinib 250 mg twice daily orally. The coprimary endpoint was objective response rate in the two cohorts., Results: From December 2014 to March 2017, 505 patients were screened and a total of 52 patients (26 patients per cohort) were enrolled onto the study. At data cutoff of September 2017, in cohort A, objective response rate was 65%, and median progression-free survival and overall survival were 22.8 months [95% confidence interval (CI) 15.2-30.3] and not reached, respectively. In cohort B, objective response rate was 27%, median progression-free survival was 4.4 months (95% CI 3.0-5.8), and overall survival was 5.4 months (95% CI, 4.2-6.5). No difference in any clinical endpoint was observed between MET -amplified and exon 14-mutated patients. No response was observed among the 5 patients with cooccurrence of a second gene alteration. No unexpected toxicity was observed in both cohorts., Conclusions: Crizotinib induces response in a fraction of MET -deregulated NSCLC. Additional studies and innovative therapies are urgently needed., (©2019 American Association for Cancer Research.)