Magnitude and duration of immune checkpoint up-regulation and changes in the immune microenvironment post chemo-radiation (CRT) in esophageal cancer.

Authors

Ronan Kelly

Ronan Joseph Kelly

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD

Ronan Joseph Kelly , Ali Hussainy Zaidi , Matthew A Smith , Ashten N Omstead , Juliann E Kosovec , Daisuke Matsui , Samantha A Martin , Christina DiCarlo , E. Day Werts , Jan F Silverman , David H. Wang , Blair Anderson Jobe

Organizations

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, The Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA, Department of Pathology and Laboratory Medicine, Allegheny Health Network, Pittsburgh, PA, Division of Radiation Oncology, Allegheny Health Network, Pittsburgh, PA, University of Texas Southwestern Simmons Cancer Center, Dallas, TX

Research Funding

Other

Background: PD-1 inhibitors in metastatic gastroesophageal cancer have demonstrated response rates of approximately 25%. Unfortunately, the majority of patients do not respond. Therefore, a rationale strategy of combining immunotherapeutic agents with CRT in earlier stage esophageal cancer may prevent metastatic disease in a greater proportion of patients. This study assessed the impact of CRT on the immune microenvironment and the expression patterns of multiple immune checkpoints to optimally design neoadjuvant clinical trials. Methods: To determine the effects of CRT on resected esophageal adenocarcinomas (EAC), we examined the immune microenvironment pre and post CRT using IHC, LCM followed by qRT-PCR, and functional analysis of tumor-infiltrating lymphocytes. Additionally, to assess the duration and dependency of radiation-induced PD-L1 sensitization, esophagojejunostomy were performed on rats to induce gastroduodenoesophageal reflux and EAC formation. First, tumor bearing animals were dosed with single fraction 13 Gy or 16 Gy radiation to determine safety, dose correlation, and PD-L1 sensitization using qRT-PCR post-radiation. Next, longitudinal PD-L1 expression levels within individual tumor bearing animals were determined using serial endoscopic biopsies at baseline, 1, 5 and 9 weeks post 16 Gy radiation. Results: The majority of cancers displayed enhanced interferon γ and activated CD8+ T lymphocytes at the tumor stroma interface. These tumors also demonstrated enhanced upregulation of PD-L1 and multiple other immune checkpoints including – TIM3, GITR, IDO1, LAG3, CD137, OX40 and KIR. The animal model results indicated PD-L1 upregulation is dose dependent and transiently elevated post radiation exposure. Conclusions: Collectively, these findings provide insights into the evolving immune landscape after CRT and have significant implications for future neoadjuvant trial designs that will combine radiotherapy with immune checkpoint inhibitors. Currently, we are conducting a neoadjuvant trial assessing Nivolumab or Nivolumab/Ipilimumab in combination with CRT in stage II/III operable esophageal cancer.

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Esophageal or Gastric Cancer

Citation

J Clin Oncol 35, 2017 (suppl; abstr 4060)

DOI

10.1200/JCO.2017.35.15_suppl.4060

Abstract #

4060

Poster Bd #

52

Abstract Disclosures

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