S Hashemi1, M F Fransen2, A Niemeijer2, N Ben Taleb2, I Houda2, J Veltman2, A Becker-Commissaris2, H Daniels2, L Crombag2, T Radonic3, G Jongeneel4, S Tarasevych5, E Looysen5, M van Laren6, M Tiemessen6, V van Diepen7, K Maassen-van den Brink7, E Thunnissen3, I Bahce2. 1. Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands. Electronic address: s.hashemi@amsterdamumc.nl. 2. Department of Pulmonology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands. 3. Department of Pathology, Amsterdam UMC, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands. 4. Department of Epidemiology & Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands. 5. Department of Pulmonology, Zaans Medisch Centrum, Zaandam, The Netherlands. 6. Department of Pulmonology, Dijklander Ziekenhuis, Hoorn, The Netherlands. 7. Department of Pulmonology, Dijklander Ziekenhuis, Purmerend, The Netherlands.
Abstract
INTRODUCTION: Immune checkpoint inhibitors (ICI), such as anti-PD-1 agents, have become part of the standard of care treatment of advanced non-small cell lung cancer (NSCLC). Predictive biomarkers are needed to identify patients that benefit from anti-PD-1 treatments. Tumor infiltrating lymphocytes (TILs) and PD-L1 are major players in the ICI mechanism of action. In this study, we assess the impact of real-world clinicopathological variables, including TILs and PD-L1, on anti-PD-1 efficacy. METHODS: We performed a monocenter retrospective study in advanced NSCLC treated with nivolumab or pembrolizumab between January 2015 and February 2019. The impact of baseline clinical and pathological variables was assessed by univariate and multivariate models. TILs, defined as CD8+T-cells, and PD-L1 were scored in tumor and stroma, and correlated with progression free survival (PFS) and overall survival (OS). RESULTS: We included 366 patients of whom 141 were assessed for tumor and stromal TILs. The median follow-up time was 487 days. In the whole cohort, PFS was associated with high tumor PD-L1, high albumin and good performance. OS was associated with low LDH, high albumin, good performance and 'first-line treatment'. In the TILs subcohort, stromal TILs had the strongest impact on PFS and OS. Stromal TILs were a stronger marker for PFS and OS than tumoral TILs, tumoral PD-L1 or stromal PD-L1. Remaining factors for PFS and OS were albumin and albumin with LDH, respectively. CONCLUSIONS: This real-world study on clinicopathological features shows that stromal CD8 + TILs were the strongest predictor for PFS and OS in patients with advanced NSCLC on anti-PD-1 therapy. Other predictors for PFS and OS included albumin and albumin together with LDH, respectively. This study highlights the pivotal role of the stromal compartment in the mechanisms of action of ICI, and the need for further studies aiming to overcome this stromal firewall.
INTRODUCTION: Immune checkpoint inhibitors (ICI), such as anti-PD-1 agents, have become part of the standard of care treatment of advanced non-small cell lung cancer (NSCLC). Predictive biomarkers are needed to identify patients that benefit from anti-PD-1 treatments. Tumor infiltrating lymphocytes (TILs) and PD-L1 are major players in the ICI mechanism of action. In this study, we assess the impact of real-world clinicopathological variables, including TILs and PD-L1, on anti-PD-1 efficacy. METHODS: We performed a monocenter retrospective study in advanced NSCLC treated with nivolumab or pembrolizumab between January 2015 and February 2019. The impact of baseline clinical and pathological variables was assessed by univariate and multivariate models. TILs, defined as CD8+T-cells, and PD-L1 were scored in tumor and stroma, and correlated with progression free survival (PFS) and overall survival (OS). RESULTS: We included 366 patients of whom 141 were assessed for tumor and stromal TILs. The median follow-up time was 487 days. In the whole cohort, PFS was associated with high tumorPD-L1, high albumin and good performance. OS was associated with low LDH, high albumin, good performance and 'first-line treatment'. In the TILs subcohort, stromal TILs had the strongest impact on PFS and OS. Stromal TILs were a stronger marker for PFS and OS than tumoral TILs, tumoral PD-L1 or stromal PD-L1. Remaining factors for PFS and OS were albumin and albumin with LDH, respectively. CONCLUSIONS: This real-world study on clinicopathological features shows that stromal CD8 + TILs were the strongest predictor for PFS and OS in patients with advanced NSCLC on anti-PD-1 therapy. Other predictors for PFS and OS included albumin and albumin together with LDH, respectively. This study highlights the pivotal role of the stromal compartment in the mechanisms of action of ICI, and the need for further studies aiming to overcome this stromal firewall.
Authors: Elke Anklam; Martin Iain Bahl; Robert Ball; Richard D Beger; Jonathan Cohen; Suzanne Fitzpatrick; Philippe Girard; Blanka Halamoda-Kenzaoui; Denise Hinton; Akihiko Hirose; Arnd Hoeveler; Masamitsu Honma; Marta Hugas; Seichi Ishida; George En Kass; Hajime Kojima; Ira Krefting; Serguei Liachenko; Yan Liu; Shane Masters; Uwe Marx; Timothy McCarthy; Tim Mercer; Anil Patri; Carmen Pelaez; Munir Pirmohamed; Stefan Platz; Alexandre Js Ribeiro; Joseph V Rodricks; Ivan Rusyn; Reza M Salek; Reinhilde Schoonjans; Primal Silva; Clive N Svendsen; Susan Sumner; Kyung Sung; Danilo Tagle; Li Tong; Weida Tong; Janny van den Eijnden-van-Raaij; Neil Vary; Tao Wang; John Waterton; May Wang; Hairuo Wen; David Wishart; Yinyin Yuan; William Slikker Journal: Exp Biol Med (Maywood) Date: 2021-11-16
Authors: Maurice van Duijvenvoorde; Sarah Derks; Idris Bahce; C René Leemans; Rieneke van de Ven; Marieke F Fransen Journal: Clin Transl Immunology Date: 2022-01-10