Novel molecular subtypes of METex14 non-small cell lung cancer with distinct biological and clinical significance

Not all MET exon 14 skipping ( MET ex14) NSCLC patients benefited from MET inhibitors. We hypothesized an inter-tumoral heterogeneity in MET ex14 NSCLC. Investigations at genomic and transcriptomic level were conducted in MET ex14 NSCLC samples from stage I-III and recurrent/metastatic patients as discovery and validation cohort. Four molecular subtypes were discovered. MET-Driven subtype, with the worst prognosis, displayed MET overexpression, enrichment of MET-related pathways, and higher infiltration of fibroblast and regulatory T cells. Immune-Activated subtype having the most idea long-term survival, had higher tertiary lymphoid structures, spatial co-option of PD-L1 + cancer cells, and GZMK + CD8 + T cell. FGFR- and Bypass-Activated subtypes displayed FGFR2 overexpression and enrichments of multiple oncogenic pathways respectively. In the validation cohort, patients with MET-Driven subtype had better response to MET inhibitors than those with MET overexpression. Thus, molecular subtypes of MET ex14 NSCLC with distinct biological and clinical significance may indicate more precise therapeutic strategies for MET ex14 NSCLC patients.