Comparative Efficacy of Adagrasib and Sotorasib in KRAS G12C-Mutant NSCLC: Insights from Pivotal Trials.

Simple Summary: Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related deaths, particularly among patients with a specific mutation in the KRAS gene known as KRAS G12C. Two targeted therapies, adagrasib and sotorasib, have been developed for this mutation. This manuscript reviews three key clinical trials that evaluated the efficacy of these drugs in patients with KRAS G12C-mutated NSCLC. We compare their effectiveness in slowing disease progression and examine their differing side effect profiles, both of which are crucial for treatment decisions. While both drugs demonstrate efficacy, their side effects can influence patient tolerance and overall experience. Understanding these differences enables physicians to make more informed choices about the most appropriate treatment for each patient. Our analysis indicates that, although the overall survival rates for both drugs are comparable, certain patients may derive greater benefits from one therapy over the other, depending on individual characteristics and the management of side effects. Background: The KRAS G12C mutation, prevalent in various malignancies, including non-small cell lung cancer (NSCLC), represents a unique therapeutic target. Adagrasib and sotorasib, two FDA-approved agents specifically targeting this mutation, have shown promise in clinical trials. This study aims to compare their efficacy in treating KRAS G12C-mutated NSCLC, drawing insights from pivotal clinical trials. Methods: We analyzed data from three key clinical trials: KRYSTAL-1, CodeBreak100, and CodeBreak200. Our methodology involved reconstructing individual patient data from published Kaplan–Meier curves using the IPDfromKM tool (Version 0.1.10). The primary endpoints were progression-free survival (PFS) and overall survival (OS), evaluated through hazard ratios (HRs) and the restricted mean survival time (RMST) method. Results: The HR for PFS favored adagrasib (HR: 0.90 [95% CI: 0.69, 1.19], p = 0.473), suggesting a non-significant trend toward better disease control compared to sotorasib. For OS, the HR was 0.99 [95% CI: 0.75, 1.33] (p = 0.969), indicating no significant difference between the two drugs. RMST analysis supported these findings, with adagrasib showing a consistently higher RMST in PFS at 6, 12, and 18 months. However, OS benefits converged over time, with adagrasib marginally surpassing sotorasib by the 18-month mark. Conclusions: This comprehensive analysis reveals that while adagrasib may offer a slight advantage in PFS, both drugs demonstrate comparable efficacy in OS for KRAS G12C-mutated NSCLC. The subtle differences observed, particularly in PFS, could inform clinical decision-making, emphasizing the need for personalized treatment strategies. Future research should focus on long-term effects and identifying patient subgroups that may benefit more from one drug over the other. [ABSTRACT FROM AUTHOR]