The tumor microenvironment and immune infiltration landscape of KRAS mutant pancreatic ductal adenocarcinomas (PDAC) compared to colorectal adenocarcinomas (CRC).

Authors

Emil Lou

Emil Lou

Masonic Cancer Center/ University of Minnesota School of Medicine, Minneapolis, MN

Emil Lou , Joanne Xiu , Yasmine Baca , Phillip Walker , Gulam Abbas Manji , Sepideh Gholami , Anwaar Saeed , Philip Agop Philip , Ajay Prakash , Igor A. Astsaturov , Greg Botta , Laith I. Abushahin , Davendra Sohal , Heinz-Josef Lenz , Anthony Frank Shields , Chadi Nabhan , Wafik S. El-Deiry , Andreas Seeber , Wolfgang Michael Korn

Organizations

Masonic Cancer Center/ University of Minnesota School of Medicine, Minneapolis, MN, Caris Life Sciences, Phoenix, AZ, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, University of California Davis Comprehensive Cancer Center, Sacramento, CA, University of Kansas Cancer Center, Westwood, KS, Karmanos Cancer Center, Wayne State University, and SWOG, Farmington Hills, MI, New York University School of Medicine, New York, NY, Fox Chase Cancer Center, Philadelphia, PA, University of California-San Diego, San Diego, CA, The Ohio State University, Comprehensive Cancer Center, Columbus, OH, Cleveland Clinic, Cleveland, OH, Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, Karmanos Cancer Institute, Wayne State University, Detroit, MI, Cancer Center at Brown University, Providence, RI, Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Comprehensive Cancer Center Innsbruck, Innsbruck, Austria

Research Funding

Pharmaceutical/Biotech Company

Background: The composition of the tumor microenvironment (TME) in PDACs is more heavily driven by mutant (mt) KRAS than any other cancer. How genomic alterations of PDAC including KRAS status affect the immune cell (IC) landscape remains unclear. Thus, we characterized IC types and the prevalence of immuno-oncologic (IO) biomarkers in PDAC by genomic and transcriptomic analysis, and investigated associations of mt KRAS with IC estimates in the TME. Our findings were compared to our previous study in CRC. Methods: A total of 4,142 PDAC and 3,727 CRC with KRAS-mts were analyzed using next-generation DNA sequencing (NextSeq, 592 gene panel or NovaSeq, WES), IHC, and whole transcriptome RNA sequencing (NovaSeq) (Caris Life Sciences, Phoenix, AZ). MSI/MMR was tested by FA, IHC and NGS. TMB-H was classified based on a cut-off of >10 mutations per MB. ICs were estimated by QuantiSeq (Finotello 2019, Genome Medicine) or MCP counter (Betcht 2016, Genome Biology). Significance was determined by X2 and Fisher-Exact and p-adjusted for multiple comparisons (q<0.05). Results: Mutant KRAS was seen in 81% of PDAC and in 48% of CRC. The most common variant was G12D, comprising 43% and 32% of all PDAC and CRC KRAS variants, respectively. The therapeutically actionable KRAS G12C variant comprises 2% and 7% of PDAC and CRC in this cohort, respectively. In PDAC, KRAS mt was associated with lower prevalence of MSI-H/dMMR than KRAS-wildtype (wt); 0.9% vs 1.9%, p=0.027). PDL1 expression was significantly lower in KRAS wt (12%) compared to G12D (19%) and G13X (33%), similar to previous observations in CRC. However, when considering TMB, in PDAC, G12D (1%), G12V (1%) and Q61 (1%) mutations had significantly lower TMB-H than RAS wt tumors (4%); in contradiction to CRC. The immune cell environment of KRAS mt PDAC showed significantly higher infiltration with M1 macrophages and cancer-associated fibroblasts (CAFs), as well as lower M2 macrophages, CD4+& CD8+ T cells, T-reg, NK, myeloid dendritic and endothelial cells compared to KRAS wt. In CRC, a similar pattern was observed but more pronounced in PDAC. Immune-regulatory markers, were among multiple genes downregulated in KRAS-mt PDAC, including CTLA-4 and LAG3. Overall changes were most pronounced in cases harboring KRAS G12D, G12V, Q61, and rare KRAS variants. Conclusions: The TME of KRAS mt PDAC shows IC patterns similar to KRAS mt CRC. Actionable IO-targets, such as PDL1, are enriched in tumors harboring specific variants of KRAS mt PDAC including the targetable G12C variant. If G12D becomes druggable, it could be targetable in 35% patients with PDAC or 15% in CRC. These results demonstrate that the TME of PDAC and CRC shows immune-cold features. Tailored immunotherapeutic strategies would have to overcome these barriers in KRAS mt PDAC and CRC, possibly in combination with molecularly targeted treatment strategies.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 4142)

DOI

10.1200/JCO.2022.40.16_suppl.4142

Abstract #

4142

Poster Bd #

127

Abstract Disclosures

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