...KEAP1 mutational co-occurrences, we identified four genes potentially associated with reduced efficacy of immunotherapy (KEAP1, PBRM1, SMARCA4 and STK11). Independent of the nature of co-occurring alterations, tumors with coexisting mutations (CoMut) had inferior survival as compared to single-mutant (SM) and wild-type (WT) tumors (bNGS cohort: CoMut vs SM log-rank P=0.048, CoMut vs WT log-rank P<0.001; tNGS cohort: CoMut vs SM log-rank P=0.037, CoMut vs WT log-rank P=0.006)....study indicates that coexisting alterations in a limited set of genes characterize a subset of LUAD unresponsive to immunotherapy and with high TMB.