Mutation in the KRAS gene as a predictor of the effectiveness of immunotherapy for non-small cell lung cancer

The purpose of the study: to conduct a systematic literature review on the effectiveness and feasibility of using information on the presence of KRas gene mutations (in different codons), tp53 (Kp), stK11/lKB1 (Kl), and Keap mutations and the association of KRasm with pd-l1 status in patients with non-small cell lung cancer (Nsclc) as a predictor of the effectiveness of immunotherapy with immune checkpoint inhibi-tors. material and methods. the review includes data from randomized clinical trials and meta-analyses on the predictive value of KRas mutation status for response to immunotherapy in patients with Nsclc over the past 10 years. Results. the presence of KRas mutations in Nsclc patients could be a predictive factor for their response to immunotherapy, as several studies have demonstrated benefit from immunotherapy in these patients. the combination of KRas mutation with tp53 (Kp) co-mutation predicts a better response to immunotherapy, while a combination with stK11/lKB1 (Kl) and Keap1 predicts a worse response (reduced response rate and overall and disease-free survival). in pd-l1-positive patients, the presence of KRas mutation is associated with a better prognosis after treatment with immunotherapy. moreover, the presence of KRas mutation is associated with a worse response to first-line and subsequent-line chemotherapy, thus indicating a more promising use of immunotherapy in these patients. conclusion. identification of tp53 (Kp), stK11/lKB1 (Kl), and Keap1 co-mutations and the presence of KRas mutation in addition to determination pd-l expression enable selection of patients who will obtain the greatest benefit from immunotherapy. in ad-dition, the ability to determine KRas mutation and co-mutation status using a liquid biopsy (with acceptable specificity and sensitivity) makes it possible to use this method for determining sensitivity to immunotherapy when it is not possible to obtain tumor sample (to determine pd1-l1 expression).