1. Loss of MHC Class I Expression in HPV-associated Cervical and Vulvar Neoplasia: A Potential Mechanism of Resistance to Checkpoint Inhibition.
- Author
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Dibbern ME, Bullock TN, Jenkins TM, Duska LR, Stoler MH, and Mills AM
- Subjects
- Antineoplastic Agents, Immunological adverse effects, B7-H1 Antigen antagonists & inhibitors, B7-H1 Antigen immunology, Carcinoma, Squamous Cell drug therapy, Carcinoma, Squamous Cell immunology, Carcinoma, Squamous Cell pathology, Down-Regulation, Female, Host-Pathogen Interactions, Humans, Papillomaviridae immunology, Papillomavirus Infections immunology, Papillomavirus Infections pathology, Programmed Cell Death 1 Receptor antagonists & inhibitors, Programmed Cell Death 1 Receptor immunology, Retrospective Studies, Squamous Intraepithelial Lesions of the Cervix drug therapy, Squamous Intraepithelial Lesions of the Cervix immunology, Squamous Intraepithelial Lesions of the Cervix pathology, Uterine Cervical Neoplasms drug therapy, Uterine Cervical Neoplasms immunology, Uterine Cervical Neoplasms pathology, Vulvar Neoplasms drug therapy, Vulvar Neoplasms immunology, Vulvar Neoplasms pathology, Antineoplastic Agents, Immunological therapeutic use, Carcinoma, Squamous Cell virology, Drug Resistance, Neoplasm, Histocompatibility Antigens Class I immunology, Papillomaviridae pathogenicity, Papillomavirus Infections virology, Squamous Intraepithelial Lesions of the Cervix virology, Uterine Cervical Neoplasms virology, Vulvar Neoplasms virology
- Abstract
Tumor cell expression of major histocompatibility complex (MHC) class I is required for antigen presentation and adaptive immune recognition. Absent or diminished MHC class I expression is thought to contribute to immunotherapeutic resistance in some epithelial tumors but has not been previously studied in cervical and vulvar carcinoma. Given that anti-programmed cell death 1 (PD-1) checkpoint inhibition is deployed for programmed cell death ligand 1 (PD-L1)-positive recurrent and metastatic cervical squamous carcinomas, identifying tumors with loss of MHC class I is of clinical interest to optimize the selection of immunotherapeutic candidates. Immunohistochemistry for PD-L1 and MHC class I combined A, B, and C heavy chains (MHC class I) was assessed in 58 human papillomavirus-associated cervical and vulvar lesions, including 27 squamous intraepithelial lesions (SILs) and 31 invasive squamous cell carcinoma (SCC). Although 84% of SCC and 22% of SIL were PD-L1-positive, 35.5% (11/31) of SCC and 18.5% (5/27) of SIL also showed clonal or complete loss of MHC class I. Loss of MHC class I expression was more common in PD-L1-positive (10/26, 38%) versus PD-L1-negative SCC (1/5, 20%). In summary, over one third of human papillomavirus-associated cervical and vulvar SCC show clonal or complete loss of MHC class I expression, including many PD-L1-positive cases. This suggests that the efficacy of checkpoint inhibitors targeting the PD-1/PD-L1 axis may be limited in a subset of cervical and vulvar squamous neoplasms due to an impaired ability to engage with the adaptive immune system related to loss of MHC class I expression.
- Published
- 2020
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