OnCo
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STK11 / KEAP1 co-mutations

aka STK11, KEAP1, co-mutation, co-mutations, co-mutated, STK11/KEAP1, LKB1, SMARCA4

Two genes whose loss, often alongside a KRAS mutation, makes lung cancer 'cold' to immunotherapy and shortens survival on standard treatment. They are the reason two KRAS-mutant lung cancers can behave completely differently.

STK11 (LKB1) and KEAP1 are inactivated in about 15-20% of lung adenocarcinomas each. Tumours with these losses have low PD-L1, few infiltrating T cells and poor responses to PD-1 blockade and chemo-immunotherapy, and KEAP1 loss also blunts chemotherapy and radiotherapy through antioxidant (NRF2) activation. They are stratification factors and exclusion criteria in modern lung trials, and are targets of dedicated strategies: glutaminase inhibition for KEAP1, and adding CTLA-4 blockade (POSEIDON subgroup) for STK11. SMARCA4 loss is a third co-mutation with similar prognostic weight.

Category
Pathology & biomarkers

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