Differential immune-related microenvironment determines PD-1/PD-L1 blockade efficacy in advanced non-small cell lung cancer patients.

Authors

null

Masayuki Shirasawa

Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan

Masayuki Shirasawa , Tatsuya Yoshida , Yukiko Shimoda , Daisuke Takayanagi , Kouya Shiraishi , Takashi Kubo , Sachiyo Mitani , Yuji Matsumoto , Ken Masuda , Yuki Shinno , Yusuke Okuma , Yasushi Goto , Hidehito Horinouchi , Hitoshi Ichikawa , Takashi Kohno , Noboru Yamamoto , Shun-ichi Watanabe , Noriko Motoi , Yuichiro Ohe

Organizations

Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan, Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan, Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan, National Cancer Center Hospital, Tokyo, Japan, Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan, Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan, Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

Research Funding

No funding received
None

Background: Programmed death ligand-1 (PD-L1) expression is not a completely reliable predictive marker of the efficacy of anti-programmed cell death protein-1 (PD-1)/anti-PD-L1 therapy in advanced non-small cell lung cancer patients (NSCLC). Immune-related tumor microenvironment (TME) is classified into four different types based on the status of tumor-infiltrating lymphocytes (TILs) and PD-L1 expression. Methods: We retrospectively reviewed advanced NSCLC patients treated with anti-PD-1/anti-PD-L1 therapy between 2015 and 2019, and investigated the association between the efficacy of anti-PD-1/anti-PD-L1 therapy, the types of TME based on PD-L1 (clone: 22C3) expression, and the density of CD8-positive TILs by immunohistochemistry (/mm2), and mutational profiles assessed by next-generation sequencing. Results: Overall, 228 patients without driver mutation (EGFR, ALK, ROS1, and RET) were included in the analysis. The patients were classified into four following groups: Type I: PD-L1High (tumor proportion score [TPS]≥50%)/TILHigh (≥85/mm2; n = 73), Type II: PD-L1Low (TPS < 50%)/TILLow ( < 85/mm2; n = 70), Type III: PD-L1High/TILLow (n = 37), and Type IV: PD-L1Low/TILHigh (n = 48). The progression-free survival (PFS) and objective response rate (ORR) of anti-PD-1/anti-PD-L1 therapy clearly differed according to the different tumor microenvironment (TME) types (ORR and median PFS; Type I: 64%, 14.5 months, Type II: 12%, 2.1 months, Type III: 24%, 3.6 months, Type IV: 41%, 10.8 months). In patients with PD-L1High tumors, Type I tumors had significantly better ORR and PFS than Type III(ORR: p < 0.001, and PFS: p < 0.001) tumors. Regarding the association between mutational profiles, histology and the TME types, the presence of TP53 mutation and KRAS mutation significantly related to TILHigh (Type I and IV) and PD-L1High tumors (Type I and III), respectively. Pleomorphic and NSCLC- not otherwise specified histology were associated with Type I tumors, while LCNEC was associated with PD-L1 low tumors (Type II and IV). Conclusions: Various factors (mutational profile and histology) are related to TME classification based on the status of TILs and PD-L1 expression. Differential types of TME, including PD-L1 expression and TILs status, can accurately predict the efficacy of anti-PD-1/anti-PD-L1 therapy.

ORR (95% CI)

(%)
PFS (95% CI)

(months)
All patients (n = 228)
36 (30-43)
5.5 (3.7-7.3)
Type I (PDL-1HighCD8High, n = 73)
64 (52-75)
14.5 (8.3-NA)
Type II (PDL-1LowCD8Low, n = 70)
12 (5-21)
2.1 (1.8-2.4)
Type III (PDL-1HighCD8Low, n = 37)
24 (12-41)
3.6 (2.3-4.9)
Type IV (PDL-1LowCD8High, n = 48)
41 (27-57)
10.8 (8.1-13.5)

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 9044)

DOI

10.1200/JCO.2021.39.15_suppl.9044

Abstract #

9044

Poster Bd #

Online Only

Abstract Disclosures

Similar Abstracts

First Author: Paul R. Walker

First Author: Colin R Lindsay