The Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA.
The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nat Med. 2024 Apr;30(4):1023-1034. doi: 10.1038/s41591-024-02877-z. Epub 2024 Mar 19.
Gastroesophageal cancer dynamics and drivers of clinical responses with immune checkpoint inhibitors (ICI) remain poorly understood. Potential synergistic activity of dual programmed cell death protein 1 (PD-1) and lymphocyte-activation gene 3 (LAG-3) inhibition may help improve immunotherapy responses for these tumors. We report a phase Ib trial that evaluated neoadjuvant nivolumab (Arm A, n = 16) or nivolumab-relatlimab (Arm B, n = 16) in combination with chemoradiotherapy in 32 patients with resectable stage II/stage III gastroesophageal cancer together with an in-depth evaluation of pathological, molecular and functional immune responses. Primary endpoint was safety; the secondary endpoint was feasibility; exploratory endpoints included pathological complete (pCR) and major pathological response (MPR), recurrence-free survival (RFS) and overall survival (OS). The study met its primary safety endpoint in Arm A, although Arm B required modification to mitigate toxicity. pCR and MPR rates were 40% and 53.5% for Arm A and 21.4% and 57.1% for Arm B. Most common adverse events were fatigue, nausea, thrombocytopenia and dermatitis. Overall, 2-year RFS and OS rates were 72.5% and 82.6%, respectively. Higher baseline programmed cell death ligand 1 (PD-L1) and LAG-3 expression were associated with deeper pathological responses. Exploratory analyses of circulating tumor DNA (ctDNA) showed that patients with undetectable ctDNA post-ICI induction, preoperatively and postoperatively had a significantly longer RFS and OS; ctDNA clearance was reflective of neoantigen-specific T cell responses. Our findings provide insights into the safety profile of combined PD-1 and LAG-3 blockade in gastroesophageal cancer and highlight the potential of ctDNA analysis to dynamically assess systemic tumor burden during neoadjuvant ICI that may open a therapeutic window for future intervention. ClinicalTrials.gov registration: NCT03044613 .
胃食管交界癌的动力学和免疫检查点抑制剂(ICI)临床反应的驱动因素仍知之甚少。双重程序性细胞死亡蛋白 1(PD-1)和淋巴细胞激活基因 3(LAG-3)抑制的潜在协同活性可能有助于提高这些肿瘤的免疫治疗反应。我们报告了一项 Ib 期临床试验,该试验评估了新辅助纳武单抗(A 组,n=16)或纳武单抗联合 relatlimab(B 组,n=16)联合放化疗在可切除的 II 期/III 期胃食管交界癌患者中的应用,同时对病理、分子和功能免疫反应进行了深入评估。主要终点是安全性;次要终点是可行性;探索性终点包括病理完全缓解(pCR)和主要病理缓解(MPR)、无复发生存(RFS)和总生存(OS)。该研究在 A 组达到了主要的安全性终点,尽管 B 组需要修改以减轻毒性。A 组的 pCR 和 MPR 率分别为 40%和 53.5%,B 组分别为 21.4%和 57.1%。最常见的不良反应是疲劳、恶心、血小板减少和皮疹。总的来说,2 年 RFS 和 OS 率分别为 72.5%和 82.6%。较高的基线程序性死亡配体 1(PD-L1)和 LAG-3 表达与更深的病理反应相关。对循环肿瘤 DNA(ctDNA)的探索性分析表明,ICI 诱导后、术前和术后 ctDNA 不可检测的患者 RFS 和 OS 显著延长;ctDNA 清除反映了新抗原特异性 T 细胞反应。我们的研究结果为胃食管交界癌中 PD-1 和 LAG-3 联合阻断的安全性概况提供了见解,并强调了 ctDNA 分析在新辅助 ICI 期间动态评估全身肿瘤负担的潜力,这可能为未来的干预打开治疗窗口。临床试验注册:NCT03044613。
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