Genentech, South San Francisco, CA, USA.
Foundation Medicine, Cambridge, MA, USA.
Nat Commun. 2021 Jun 25;12(1):3969. doi: 10.1038/s41467-021-24112-w.
Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis lead to durable clinical responses in subsets of cancer patients across multiple indications, including non-small cell lung cancer (NSCLC), urothelial carcinoma (UC) and renal cell carcinoma (RCC). Herein, we complement PD-L1 immunohistochemistry (IHC) and tumor mutation burden (TMB) with RNA-seq in 366 patients to identify unifying and indication-specific molecular profiles that can predict response to checkpoint blockade across these tumor types. Multiple machine learning approaches failed to identify a baseline transcriptional signature highly predictive of response across these indications. Signatures described previously for immune checkpoint inhibitors also failed to validate. At the pathway level, significant heterogeneity is observed between indications, in particular within the PD-L1 tumors. mUC and NSCLC are molecularly aligned, with cell cycle and DNA damage repair genes associated with response in PD-L1- tumors. At the gene level, the CDK4/6 inhibitor CDKN2A is identified as a significant transcriptional correlate of response, highlighting the association of non-immune pathways to the outcome of checkpoint blockade. This cross-indication analysis reveals molecular heterogeneity between mUC, NSCLC and RCC tumors, suggesting that indication-specific molecular approaches should be prioritized to formulate treatment strategies.
针对 PD-1/PD-L1 轴的免疫检查点抑制剂在多种适应症的癌症患者亚组中导致持久的临床反应,包括非小细胞肺癌(NSCLC)、尿路上皮癌(UC)和肾细胞癌(RCC)。在此,我们通过 RNA-seq 对 366 名患者的 PD-L1 免疫组化(IHC)和肿瘤突变负担(TMB)进行了补充,以确定能够预测这些肿瘤类型对检查点阻断反应的统一和适应症特异性分子谱。多种机器学习方法未能确定一个对这些适应症具有高度预测性的基线转录特征。以前描述的用于免疫检查点抑制剂的特征也未能得到验证。在通路水平上,不同适应症之间存在显著的异质性,特别是在 PD-L1 肿瘤中。mUC 和 NSCLC 在分子上是一致的,与 PD-L1-肿瘤中反应相关的细胞周期和 DNA 损伤修复基因。在基因水平上,CDK4/6 抑制剂 CDKN2A 被确定为反应的重要转录相关性,突出了非免疫途径与检查点阻断结果的关联。这种跨适应症分析揭示了 mUC、NSCLC 和 RCC 肿瘤之间的分子异质性,表明应该优先考虑适应症特异性分子方法来制定治疗策略。
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