Galsky Matthew D, Bajorin Dean F, Tomita Yoshihiko, Ye Dingwei, Agerbaek Mads, Enting Deborah, Peer Avivit, Milowsky Matthew, Kobayashi Ko, Grimm Marc-Oliver, Stenner Frank, David Justin M, Li Jun, Chasalow Scott D, Nasroulah Federico, Apfel Abraham, Ünsal-Kaçmaz Keziban, Necchi Andrea
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nat Med. 2025 Aug 7. doi: 10.1038/s41591-025-03802-8.
Nivolumab monotherapy has been approved for the adjuvant treatment of adult patients with urothelial carcinoma who are at high risk of recurrence after undergoing radical resection of urothelial carcinoma based on results of the phase 3 CheckMate 274 trial, in which adjuvant nivolumab versus placebo demonstrated improvement in the primary endpoint of disease-free survival (DFS) in high-risk muscle-invasive urothelial carcinoma (MIUC). Identification of biomarkers associated with treatment outcomes can help refine patient selection, and inform on the immunobiology of disease. To assess the relevance of key biomarkers in the adjuvant MIUC setting, extensive exploratory analyses of tumor biomarkers, including associations with DFS, were performed. Differential gene expression and gene signature analysis found that immune-related genes and pathways, in particular a high interferon-γ signature, were predictive of improved DFS in nivolumab-treated patients. Positive predictive and prognostic associations, respectively, were found for CD4 gene expression and measures of CD8 T cell infiltration. A composite predictive model suggested that high tumor cell PD-L1 expression, high CD4 gene expression, high tumor mutational burden score, receipt of neoadjuvant cisplatin and low transforming growth factor-β gene signature score made the greatest contributions to predicting improved outcomes in nivolumab-treated patients. These results reinforce studies establishing the importance of tumor biomarkers of adaptive immunity in influencing response to PD-1-PD-L1 blockade, indicating the potential predictive rather than solely prognostic nature of such findings. ClinicalTrials.gov identifier: NCT02632409 .
基于3期CheckMate 274试验的结果,纳武利尤单抗单药疗法已被批准用于辅助治疗尿路上皮癌根治性切除术后复发风险高的成年患者,在该试验中,辅助纳武利尤单抗与安慰剂相比,高危肌层浸润性尿路上皮癌(MIUC)的无病生存期(DFS)这一主要终点得到改善。识别与治疗结果相关的生物标志物有助于优化患者选择,并为疾病的免疫生物学提供信息。为了评估关键生物标志物在辅助MIUC治疗中的相关性,对肿瘤生物标志物进行了广泛的探索性分析,包括与DFS的相关性分析。差异基因表达和基因特征分析发现,免疫相关基因和通路,特别是高干扰素-γ特征,可预测纳武利尤单抗治疗患者的DFS改善。分别发现CD4基因表达与CD8 T细胞浸润指标具有阳性预测和预后相关性。一个综合预测模型表明,高肿瘤细胞PD-L1表达、高CD4基因表达、高肿瘤突变负荷评分、接受新辅助顺铂治疗以及低转化生长因子-β基因特征评分对预测纳武利尤单抗治疗患者的改善结果贡献最大。这些结果强化了相关研究,确立了适应性免疫肿瘤生物标志物在影响对PD-1-PD-L1阻断反应中的重要性,表明这些发现具有潜在的预测性而非仅仅是预后性。ClinicalTrials.gov标识符:NCT02632409 。
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