1. Integration of peripheral blood- and tissue-based biomarkers of response to immune checkpoint blockade in urothelial carcinoma.
- Author
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Vanguri RS, Smithy JW, Li Y, Zhuang M, Maher CA, Aleynick N, Peng X, Al-Ahmadie H, Funt SA, Rosenberg JE, Iyer G, Bajorin D, Mathews JC, Nadeem S, Panageas KS, Shen R, Callahan MK, and Hollmann TJ
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Urinary Bladder Neoplasms drug therapy, Urinary Bladder Neoplasms immunology, Urinary Bladder Neoplasms pathology, Progression-Free Survival, Aged, 80 and over, Carcinoma, Transitional Cell drug therapy, Carcinoma, Transitional Cell immunology, Carcinoma, Transitional Cell pathology, Lymphocytes, Tumor-Infiltrating immunology, Nivolumab therapeutic use, Urologic Neoplasms drug therapy, Urologic Neoplasms pathology, Urologic Neoplasms immunology, Ipilimumab therapeutic use, Treatment Outcome, Immune Checkpoint Inhibitors therapeutic use, Biomarkers, Tumor metabolism
- Abstract
As predictive biomarkers of response to immune checkpoint inhibitors (ICIs) remain a major unmet clinical need in patients with urothelial carcinoma (UC), we sought to identify tissue-based immune biomarkers of clinical benefit to ICIs using multiplex immunofluorescence and to integrate these findings with previously identified peripheral blood biomarkers of response. Fifty-five pretreatment and 12 paired on-treatment UC specimens were identified from patients treated with nivolumab with or without ipilimumab. Whole tissue sections were stained with a 12-plex mIF panel, including CD8, PD-1/CD279, PD-L1/CD274, CD68, CD3, CD4, FoxP3, TCF1/7, Ki67, LAG-3, MHC-II/HLA-DR, and pancytokeratin+SOX10 to identify over three million cells. Immune tissue densities were compared to progression-free survival (PFS) and best overall response (BOR) by RECIST version 1.1. Correlation coefficients were calculated between tissue-based and circulating immune populations. The frequency of intratumoral CD3
+ LAG-3+ cells was higher in responders compared to nonresponders (p = 0.0001). LAG-3+ cellular aggregates were associated with response, including CD3+ LAG-3+ in proximity to CD3+ (p = 0.01). Exploratory multivariate modeling showed an association between intratumoral CD3+ LAG-3+ cells and improved PFS independent of prognostic clinical factors (log HR -7.0; 95% confidence interval [CI] -12.7 to -1.4), as well as established biomarkers predictive of ICI response (log HR -5.0; 95% CI -9.8 to -0.2). Intratumoral LAG-3+ immune cell populations warrant further study as a predictive biomarker of clinical benefit to ICIs. Differences in LAG-3+ lymphocyte populations across the intratumoral and peripheral compartments may provide complementary information that could inform the future development of multimodal composite biomarkers of ICI response. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland., (© 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.)- Published
- 2023
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