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
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) |
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