Variation in FOLFOX, FOLFIRI, and FOLFOXIRI effects on CD8+ T cell and PDL1 levels in MSS CRC patients.

Authors

null

Lindsey Carlsen

Brown University, Providence, RI

Lindsey Carlsen , Andrew Elliott , Marzia Capelletti , Emil Lou , John Marshall , Heinz-Josef Lenz , Philip A. Philip , Michael J. Hall , George W. Sledge Jr., Alexander G Raufi , Rimini Breakstone , Khaldoun Almhanna , Benedito A. Carneiro , Howard Safran , Wafik S. El-Deiry

Organizations

Brown University, Providence, RI, Caris Life Sciences, Phoenix, AZ, CARIS Life Sciences, Irving, TX, University of Minnesota, Minneapolis, MN, Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, Karmanos Cancer Institute, Detroit, MI, Fox Chase Cancer Center, Philadelphia, PA, Brown Unversity School of Medicine-Rhode Island Hospital, Providence, RI, Brown University, The Miriam Hospital, Providence, RI, Legorreta Cancer Center, Brown University, Providence, RI, Brown University School of Medicine-Rhode Island Hospital, Providence, RI

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Colorectal cancer (CRC) is a heterogenous disease treated with FOLFOX, FOLFIRI, and FOLFOXIRI chemotherapy regimens. About 85% of CRC patients have microsatellite stable (MSS) tumors that resist immune checkpoint blockade (ICB). Some studies suggest that chemotherapy modulates the MSS CRC tumor microenvironment (TME) to enhance CD8+ T cell infiltration, but ICB remains ineffective. We evaluated the TME of MSS CRC patients to investigate chemotherapy impact on immune markers. Methods: CRC patient samples (n = 16,827) underwent DNA (592-gene or whole exome)/RNA (whole transcriptome) sequencing at Caris Life Sciences. Immune cell fractions within TMEs were estimated from RNA deconvolution (quanTIseq; Finotello, 2019; n = 11,109). PDL1 expression was assessed by IHC (SP142; ≥2+/5%). Patients who received FOLFOX (n = 425), FOLFIRI (n = 88), or FOLFOXIRI (n = 19) < 1 year prior to tumor collection or who didn’t receive these treatments > 4000 days before tumor collection (untreated, n = 6,608) were analyzed. Statistical significance was determined using chi-square, Fisher’s exact, and Mann-Whitney U tests, where appropriate. Results: FOLFOX-treated CRC (n = 213) had a higher CD8+ T cell fraction vs untreated (n = 3,449, FC = 1.9, p < 0.01) CRC and there was no difference among FOLFIRI-treated (n = 37, FC = 1.1, p = 0.13) or FOLFOXIRI-treated (n = 9, FC = 2.2, p = 0.49) CRC. Survival outcomes were similar in FOLFOX-treated CD8+ T cell-high (n = 82) vs low (n = 161, HR = 1.3, p = 0.12) and in FOLFOX-treated PDL1+ (n = 13) vs PDL1- (n = 338) CRC (HR = 1.6, p = 0.14). The CD8+ T cell fraction was similar in untreated KRAS wild-type (WT, n = 1714) vs untreated KRAS-mutated (mut, n = 1718) CRC (FC = 1.3, p < 0.01). FOLFOX-treated KRAS-mut CRC had a higher CD8+ T cell fraction (n = 1718 untreated, 96 treated, FC = 2.3, p < 0.01) and CD69 expression (n = 1724 untreated, 97 treated, FC = 1.7, p < 0.01) vs untreated KRAS-mut CRC. This FOLFOX-dependent effect on CD8+ T cells was lower in WT KRAS CRC (n = 114 FOLFOX-treated, n = 1714 untreated, FC = 1.6, p < 0.01) but survival outcomes were similar in FOLFOX-treated WT (n = 210) vs KRAS-mut (n = 210) CRC (HR = 1.0, p = 0.82). The CD8+ T cell fraction was similar in untreated right- (R; n = 803) vs left-sided CRC (L; n = 927, FC = 1.3, p < 0.01) but PDL1+ IHC rates were significantly higher in R-CRC (n = 1340 L, 1124 R, FC = 2.2, p < 0.01). The CD8+ T cell fraction was similar in untreated WT (n = 3144) vs BRAF-mut CRC (n = 248, FC = 0.8, p < 0.01), but BRAF-mut were more frequently PDL1+ (n = 4622 WT, 340 mut, FC = 4.2, p < 0.01). PDL1+ rates were similar in untreated (n = 1124) vs FOLFIRI-treated R-CRC (n = 12, FC = 2.0, p = 0.46) but were higher in FOLFIRI-treated (n = 9) vs untreated (n = 1340) L-CRC (n = 9, FC = 6.0, p = 0.04). Conclusions: We describe an association between FOLFOX and subsequent infiltration by CD8+ T-cells and high PDL1+ rates in R-CRC, BRAF-mut CRC, and FOLFIRI-treated L-CRC. The findings provide insights for future therapeutic strategies.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Biologic Correlates

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 3526)

DOI

10.1200/JCO.2023.41.16_suppl.3526

Abstract #

3526

Poster Bd #

226

Abstract Disclosures