Biomarker analysis from the phase 3 CheckMate 9ER trial of nivolumab + cabozantinib v sunitinib for advanced renal cell carcinoma (aRCC).

Authors

Toni Choueiri

Toni K. Choueiri

Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA

Toni K. Choueiri , Robert J. Motzer , Thomas Powles , Mauricio Burotto , Andrea B. Apolo , Bernard Escudier , Yoshihiko Tomita , David F. McDermott , David A. Braun , Celine Han , George Lee , Bhakti Dwivedi , Sai Vikram Vemula , Jun Li , Viktor Fedorov , Saurabh Gupta

Organizations

Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, Memorial Sloan Kettering Cancer Center, New York, NY, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust, London, United Kingdom, Bradford Hill Clinical Research Center, Santiago, Chile, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, Gustave Roussy, Villejuif, France, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, Beth Israel Deaconess Medical Center, Boston, MA, School of Medicine, Yale University, New Haven, CT, Bristol Myers Squibb, Princeton, NJ

Research Funding

Pharmaceutical/Biotech Company
Bristol Myers Squibb

Background: Prior studies investigated determinants of anti–PD-L1 ± anti-angiogenic response in aRCC. The mechanisms underlying response to first-line anti–PD-1 + VEGF-targeted therapy (anti-VEGF) remain largely unknown. In this exploratory post hoc analysis we conducted an analysis of anti–PD-1 (N) + anti-VEGF (C) v S by assessing potential predictive biomarkers for efficacy in CheckMate 9ER. Analyzed biomarkers included CD8 T-cell frequency (% of total tumor cells, CD8%), CD8 topology, PD-L1 immunohistochemistry, gene set enrichment analysis (GSEA), and 7 gene expression signatures (GES). Methods: Progression-free survival (PFS) and overall survival (OS) were evaluated by tumor PD-L1 expression (< 1% or ≥ 1%), CD8% (low, medium, high by tertiles), and CD8 topology phenotype (desert, excluded, inflamed), and assessed for association using Kaplan–Meier (KM) methods with log-rank test (PD-L1 and CD8), and Cox proportional hazard (Cox PH) models (CD8) (to avoid arbitrary or biased categorization of continuous-valued predictor variables, a potential limitation of KM analyses). Pre-ranked GSEA was performed to assess enrichment for hallmark gene sets using all genes ranked by interaction effect estimates derived using Cox PH regression. Seven GES (Angio, Myeloid, Teff, TIS, IFN-γ, EMT8, Javelin), including several previously found to be predictive of anti-PD-L1 ± anti-VEGF outcomes, were assessed for association with PFS within treatment arms. Results: At 44 mo median follow-up, median PFS and OS were improved with N+C v S regardless of PD-L1 status. PD-L1 < 1% v ≥ 1% was associated with longer median PFS in the S arm only (P = 0.00011). In KM analyses, higher CD8% was associated with improvements in PFS with N+C, but not S. Of the 410 patients (pts) in the CD8 topology analysis, the predominant CD8 phenotype was inflamed (44.6%), then desert (38.5%) and excluded (16.8%). CD8 topology supported an association between the inflamed phenotype and improved survival outcomes with N+C v S (PFS, P< 0.0001; OS, P = 0.0016). However, these associations were not confirmed in Cox PH models. Common hallmark gene sets with positive enrichment (with false discovery rate < 0.05) in genes associated with longer PFS and OS with N+C v S included oxidative phosphorylation, hypoxia, adipogenesis and P53 pathway. Pts receiving N+C had longer median PFS in the high IFN-γ GES tertile (P = 0.041) and shorter median PFS in the high EMT8 tertile (P= 0.013). However, all 7 GES tested, including IFN-γ and EMT8, were not predictive for N+C outcomes in Cox PH models. Conclusions: In this exploratory post hoc analysis, biomarkers previously found to be predictive of anti-PD-L1 ± anti-VEGF outcomes, including established GES, were not predictive of efficacy with anti-PD-1 + anti-VEGF (N+C) using Cox PH models. This suggests that key determinants of response to anti–PD-1 v anti–PD-L1 therapies may differ. Clinical trial information: NCT03141177.

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

2023 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer; Adrenal, Penile, Urethral and Testicular Cancers

Track

Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Translational Research, Tumor Biology, Biomarkers, and Pathology

Clinical Trial Registration Number

NCT03141177

Citation

J Clin Oncol 41, 2023 (suppl 6; abstr 608)

DOI

10.1200/JCO.2023.41.6_suppl.608

Abstract #

608

Poster Bd #

D7

Abstract Disclosures

Similar Abstracts

First Author: Mauricio Burotto

First Author: Maria Teresa Bourlon

Abstract

2024 ASCO Gastrointestinal Cancers Symposium

Noninvasive assessment of programmed-death ligand-1 (PD-L1) in esophagogastric (EG) cancer using 18F-BMS-986229 PET.

First Author: Samuel Louis Cytryn