Parker Institute for Cancer Immunotherapy, San Francisco, CA
Lacey J. Padrón , Deena M. Maurer , Mark H. O'Hara , Eileen Mary O'Reilly , Robert A. Wolff , Zev A. Wainberg , Andrew H. Ko , George A. Fisher Jr., Osama E. Rahma , Christopher R. Cabanski , Jia Yu , Shannon M. Pfeiffer , Marko Spasic , Travis J Hollmann , Richard Chen , Jill O'Donnell-Tormey , Samantha Bucktrout , Theresa LaVallee , Robert H. Vonderheide , Jaclyn P. Lyman
Background: Preclinical and small clinical studies of chemoimmunotherapy for metastatic pancreatic ductal adenocarcinoma (mPDAC) point to a yet unrealized potential of clinically significant immune activation. In our phase II study of the CD40 agonist antibody sotigalimab (sotiga) and/or nivolumab (nivo) with gemcitabine and nab-paclitaxel (chemo), we observed promising improvements in overall survival (OS) in 105 patients with newly diagnosed mPDAC (NCT03214250); the primary endpoint of 1-year OS rate was 57.7% (p = 0.006) in the nivo/chemo arm, 48.1% (p = 0.062) in the sotiga/chemo arm and 41.3% (p = 0.233) in the nivo/sotiga/chemo arm (O’Hara, ASCO 2021) as compared to a historical control of 35%. Here, we report results of multi-omic translational analyses designed to identify signatures predictive of OS benefit. Methods: Longitudinal blood and tumor tissue samples were collected for immune and tumor biomarker analysis. Tumor samples underwent RNA sequencing and multiplex immunofluorescence (mIF). Peripheral blood was analyzed by mass cytometry time of flight (CyTOF), high parameter flow cytometry, and proteomics. Machine learning (ML) algorithms were applied to the data to identify biosignatures related to OS in each arm. Results: Comprehensive multi-omic, multi-parameter immune and tumor biomarker analyses identified distinct pretreatment immune signatures predictive of longer OS specific to nivo/chemo or sotiga/chemo (Table, representative examples). Because patients in each arm received chemotherapy, these and other arm-unique biomarkers suggest a relationship to the immunotherapy rather than chemotherapy in this randomized study. There was evidence of immune exhaustion in the sotiga/nivo/chemo arm that may explain the lack of survival benefit. Conclusions: From in-depth translational and ML analyses of randomized phase II trial of first-line chemoimmunotherapy in mPDAC patients, we identified novel biomarkers that associated with OS distinctly in each arm. Clinical trials in first-line mPDAC exploiting these previously unappreciated biomarkers and aiming to enrich patients for response, are warranted to further advance chemoimmunotherapy in this disease. Clinical trial information: NCT03214250.
Immune Feature | Sample | Nivo/Chemo (p-value, by log rank) | Sotiga/Chemo (p-value, by log rank) |
---|---|---|---|
Lower expression of TNF-α signaling via NFκB hallmark gene signature | Tumor | 0.001 | Not significant (ns) |
Lower expression of the E2F targets hallmark gene signature | Tumor | ns | 0.021 |
Higher frequencies of Tfh cells | Blood | < 0.0001 | ns |
Higher frequencies of PD-1+ CD39+ CD4 Central Memory T cells | Blood | 0.037 | ns |
Higher frequencies of Tbet+ Eomes+ CD4 T cells | Blood | ns | 0.013 |
Higher frequencies of PD-1+ Tbet+ CD4 T cells | Blood | ns | 0.004 |
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 Disclosures
2021 ASCO Annual Meeting
First Author: Mark H. O'Hara
2022 ASCO Genitourinary Cancers Symposium
First Author: Emilien Billon
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Yan-Shen Shan
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Valerie Gunchick