Sotorasib as first-line therapy in patients with advanced non-small cell lung cancer with KRAS gene mutations combined with brain metastases: a case report

Background: Non-small cell lung cancer (NSCLC) has a high incidence of lung cancer, with a 30% incidence of KRAS mutations and a low 5-year survival rate. Until the Food and Drug Administration (FDA) approved sotorasib in May 2021, no therapies targeted mutated KRAS in cancer. Sotorasib, a new KRAS inhibitor, is currently recognized as the newest clinically targeted agent with apparent clinical efficacy in NSCLC patients with KRAS G12C mutations. FDA approval is required for patients with advanced or metastatic NSCLC undergoing at least one chemotherapy regimen. Case Description: In our study, we report a patient with advanced NSCLC combined with brain metastases, clinical stage IV (c.T3N0M1b), KRAS G12C (+) detected by next-generation sequencing (NGS) technology, direct use of sotorasib, an inhibitor of KRAS G12C, as first-line therapy. The patient was treated with 4 months of oral therapy, had significant partial remission (PR), and remained in stable disease (SD) for nearly 9 months of follow-up, with no other side effects. Further extension of the follow-up period is needed to assess the impact of sotorasib as first-line therapy on patient survival. A series of clinical trials in phase 3 is ongoing, covering the first-line usage widespread. Conclusions: Based on the literature review, this is the first domestic report in China where sotorasib was used directly as first-line treatment in patients with advanced combined brain metastasis from NSCLC. It needs a longer follow-up to evaluate the efficacy of sotorasib further as a first-line.