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Adagrasib in Non–Small-Cell Lung Cancer Harboring a KRAS G12C Mutation
Open accessAbstract
BACKGROUND: , locking it in its inactive state. Adagrasib showed clinical activity and had an acceptable adverse-event profile in the phase 1-1b part of the KRYSTAL-1 phase 1-2 study. METHODS: -mutated non-small-cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy and anti-programmed death 1 or programmed death ligand 1 therapy. The primary end point was objective response assessed by blinded independent central review. Secondary end points included the duration of response, progression-free survival, overall survival, and safety. RESULTS: -mutated NSCLC had been treated (median follow-up, 12.9 months); 98.3% had previously received both chemotherapy and immunotherapy. Of 112 patients with measurable disease at baseline, 48 (42.9%) had a confirmed objective response. The median duration of response was 8.5 months (95% confidence interval [CI], 6.2 to 13.8), and the median progression-free survival was 6.5 months (95% CI, 4.7 to 8.4). As of January 15, 2022 (median follow-up, 15.6 months), the median overall survival was 12.6 months (95% CI, 9.2 to 19.2). Among 33 patients with previously treated, stable central nervous system metastases, the intracranial confirmed objective response rate was 33.3% (95% CI, 18.0 to 51.8). Treatment-related adverse events occurred in 97.4% of the patients - grade 1 or 2 in 52.6% and grade 3 or higher in 44.8% (including two grade 5 events) - and resulted in drug discontinuation in 6.9% of patients. CONCLUSIONS: -mutated NSCLC, adagrasib showed clinical efficacy without new safety signals. (Funded by Mirati Therapeutics; ClinicalTrials.gov number, NCT03785249.).
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These results indicate the rapid development of acquired resistance to KRAS G12C inhibitors [18, 26, 27, 49].”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The phase II portion of KRYSTAL-2 included 116 patients with KRAS G12C NSCLC treated with adagrasib 600 mg bid [100]. All patients had prior platinum-doublet chemotherapy and 98.3% had received both chemotherapy and checkpoint inhibitor therapy. With a median follow-up of 12.9 months, the ORR was 42.9%.”
From Drugging KRAS: Current perspectives and state-of-art review (2022) · cites this paper as [100]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The data from both CodeBreak 100 for sotorasib and KRYSTAL-1 for adagrasib led to the approval of these inhibitors to treat G12C-mutant NSCLC [51,53,94].”
From KRAS: Biology, Inhibition, and Mechanisms of Inhibitor Resistance (2024) · cites this paper as [94]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In clinical trials, the inactive-state KRASG12C mutant-specific inhibitors adagrasib (MRTX849) and sotorasib (AMG510) achieved 37–43% anti-tumor response rates in NSCLC patients with most experiencing disease progression 6–12 months after initiation of therapy7–9.”
From Combined inhibition of KRASG12C and mTORC1 kinase is synergistic in non-small cell lung cancer (2024) · cites this paper as [8]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“STK11/LKB1 loss and KEAP1 mutations may contribute to lack of response to different therapies including anti-PD-(L)1 immune checkpoint inhibitors9,10 and KRASG12C inhibitors3,4.”
From LKB1 regulates JNK-dependent stress signaling and apoptotic dependency of KRAS-mutant lung cancers (2025) · cites this paper as [3]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For adagrasib, an ORR was 23.0% in CRC, compared to 42.8% in NSCLC (Table 1) [27, 48].”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Colorectal cancer, in particular, has a markedly lower response rate to KRAS G12C inhibitors compared to non-small cell lung cancer.”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Furthermore, the therapeutic response to KRAS G12C inhibition was short-lived, with quick emergence of acquired resistance.”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Even in NSCLC patients, the response to KRAS G12C inhibitors was often short-lived, with a DOR of 10.9–11.1 months and PFS of 6.3–6.8 months for sotorasib, and a DOR of 8.5 months and PFS of 6.5 months for adagrasib (Table 1).”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For example, sotorasib, adagrasib, and divarasib monotherapies have demonstrated objective response rates ranging from 7.1% to 53.4% and median progression-free survival of 4.0-13.1 months, 13-20”
From Anti-tumor efficacy of HRS-4642 and its potential combination with proteasome inhibition in KRAS G12D-mutant cancer (2024) · cites this paper as [18]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The overall response rate of inactive-state KRASG12C inhibitors sotorasib and adagrasib in patients with KRASG12C mutant NSCLC is 37-43%, a major advance albeit with significant room for improvement7,8.”
From Combined inhibition of KRASG12C and mTORC1 kinase is synergistic in non-small cell lung cancer (2024) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“This is further supported by a numerically higher ORR seen with divarasib in patients with non-small cell lung cancer (56.4%) compared with sotorasib (37% in a phase 2 trial and 28% in a phase 3 trial) and adagrasib (43% in a phase 2 trial)11,23–25.”
From Divarasib plus cetuximab in KRAS G12C-positive colorectal cancer: a phase 1b trial (2024) · cites this paper as [24]
The cited source says what the claim attributes to it.
In the citing paper
“Clinical studies have shown that many patients with KRAS G12C cancers did not respond to sotorasib and adagrasib.”
From Differential Response and Resistance to KRAS-Targeted Therapy (2025) · cites this paper as [27]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Because KRAS mutations are often clonal founder events, mutant KRAS ctDNA can serve as a highly informative molecular marker for tumor burden, treatment response, minimal residual disease, and emergence of resistance [29,47,77,78].”
From Precision Targeting of KRAS-Mutant Cancers: Beyond G12C Toward G12D and Pan-RAS Therapeutic Strategies (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredIn the citing paper
“Adagrasib is a selective, irreversible inhibitor of KRASG12C and has favorable properties, including long half-life (23 hours), dose-dependent pharmacokinetics, and central nervous system penetration (3–5).”
From Efficacy and Safety of Adagrasib plus Cetuximab in Patients with KRAS G12C-Mutated Metastatic Colorectal Cancer (2024) · cites this paper as [4]
In the citing paper
“Adagrasib is a selective, irreversible inhibitor of KRASG12C and has favorable properties, including long half-life (23 hours), dose-dependent pharmacokinetics, and central nervous system penetration (3–5).”
From Efficacy and Safety of Adagrasib plus Cetuximab in Patients with KRAS G12C-Mutated Metastatic Colorectal Cancer (2024) · cites this paper as [4]
In the citing paper
“Adagrasib is a selective, irreversible inhibitor of KRASG12C and has favorable properties, including long half-life (23 hours), dose-dependent pharmacokinetics, and central nervous system penetration (3–5).”
From Efficacy and Safety of Adagrasib plus Cetuximab in Patients with KRAS G12C-Mutated Metastatic Colorectal Cancer (2024) · cites this paper as [4]
In the citing paper
“Adagrasib is a selective, irreversible inhibitor of KRASG12C and has favorable properties, including long half-life (23 hours), dose-dependent pharmacokinetics, and central nervous system penetration (3–5).”
From Efficacy and Safety of Adagrasib plus Cetuximab in Patients with KRAS G12C-Mutated Metastatic Colorectal Cancer (2024) · cites this paper as [4]
In the citing paper
“Adagrasib is a selective and irreversible oral small-molecule inhibitor of the mutant KRAS G12C protein18 and was recently approved by the FDA for treatment of NSCLC who have received at least 1 prior systemic therapy19.”
From Early Changes in Circulating Cell-Free KRAS G12C Predict Response to Adagrasib in KRAS Mutant Non–Small Cell Lung Cancer Patients (2023) · cites this paper as [19]
In the citing paper
“This subset of patients that were evaluable for longitudinal KRASG12C ctDNA response in Cohort A exhibited a slightly higher ORR (56.4%, 22/39 cycle ctDNA response evaluable) compared to Cohort A overall (50.5%, 48/95 RECIST 1.1 evaluable patients)19”
From Early Changes in Circulating Cell-Free KRAS G12C Predict Response to Adagrasib in KRAS Mutant Non–Small Cell Lung Cancer Patients (2023) · cites this paper as [19]
In the citing paper
“Updated data from 116 patients with previously treated NSCLC included in a registrational phase II cohort of KRYSTAL-1 showed an ORR of 42.9%, a DCR of 79.5%, median DoR of 8.5 months, median PFS of 6.5 months, median OS of 12.6 months and estimated 1-year OS of 50.8% with adagrasib83.”
From The current state of the art and future trends in RAS-targeted cancer therapies (2022) · cites this paper as [83]
In the citing paper
“While these drugs clearly have clinical activity, overall response rates (30-40%) and disease control (~60%) in NSCLC are modest and transient, with median duration less than one year (9,10).”
From Genome-Wide CRISPR Screens Identify Multiple Synthetic Lethal Targets That Enhance KRASG12C Inhibitor Efficacy (2023) · cites this paper as [10]
In the citing paper
“Multiple mechanisms of intrinsic and acquired resistance (10,12,13), have been identified; hence, drug combinations will likely be needed to maximize the clinical efficacy of G12Cis (and probably other, emerging KRAS inhibitors) in NSCLC and other diseases.”
From Genome-Wide CRISPR Screens Identify Multiple Synthetic Lethal Targets That Enhance KRASG12C Inhibitor Efficacy (2023) · cites this paper as [10]
In the citing paper
“Among 33 patients with previously treated, stable central nervous system metastases, the intracranial confirmed objective response rate was 33.3% (95% CI, 18.0–51.8) [100].”
From Drugging KRAS: Current perspectives and state-of-art review (2022) · cites this paper as [100]
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- Mirati Therapeutics. U.S. Food and Drug Administration (FDA) accepts Mirati Therapeutics’ new drug application for adagrasib as treatment of previously treated KRASG12C-mutated non-small cell lung cancer. February 15 2022 (https://ir.mirati.com/press-releases/press-release-details/2022/U.S.-Food-and-Drug-Administration-FDA-Accepts-Mirati-Therapeutics-New-Drug-Application-for-Adagrasib-as-Treatment-of-Previously-Treated-KRASG12C-Mutated-Non-Small-Cell-Lung-Cancer/default.aspx).
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Metadata
- Authors
- Jänne, P. A., Riely, G. J., Gadgeel, S. M., Heist, R. S., Ou, S.-H. I., Pacheco, J. M., Johnson, M. L., Sabari, J. K., Leventakos, K., Yau, E., Bazhenova, L., Negrao, M. V., Pennell, N. A., Zhang, J., Anderes, K., Der-Torossian, H., Kheoh, T., Velastegui, K., Yan, X., Christensen, J. G., Chao, R. C., & Spira, A. I.
- Affiliations
- From the Lowe Center for Thoracic Oncology, Dana–Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) — both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) — all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) — all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at...
- Roswell Park Comprehensive Cancer Center (US)
- ORCID
- Riely, Gregory J.
- Gadgeel, Shirish M.
- Heist, Rebecca S.
- Ou, Sai-Hong I.
- Johnson, Melissa L.
- Sabari, Joshua K.
- Leventakos, Konstantinos
- Yau, Edwin
- Bazhenova, Lyudmila
- Negrao, Marcelo V.
- Pennell, Nathan A.
- Zhang, Jun
- Anderes, Kenna
- Kheoh, Thian
- Velastegui, Karen
- Christensen, James G.
- Chao, Richard C.
- Spira, Alexander I.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2022-07-14
- Volume
- 387
- Issue
- 2
- Pages
- 120-131
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W4281650778
- Cited by
- 1,061
- References
- 27
- Citations by year
- 2026: 247 · 2025: 270 · 2024: 285 · 2023: 203 · 2022: 56
- FWCI
- 131.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mirati Therapeutics, Inc.
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- adagrasib, KRAS G12C mutation, non-small cell lung cancer, KRAS inhibitors, objective response rate, progression-free survival, overall survival, central nervous system metastasis, treatment-related adverse events, previously treated patients
- MeSH terms
- Acetonitriles, Antineoplastic Agents, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Mutation, Piperazines, Pyrimidines, Proto-Oncogene Proteins p21(ras)
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