University of California San Diego, Moores Cancer Center, La Jolla, CA
Peter Moussa , Razelle Kurzrock , Daisuke Nishizaki , Hirotaka Miyashita , Suzanna Lee , Mina Nikanjam , Ramez Nassef Eskander , Hitendra Patel , Gregory P. Botta , Sarabjot Pabla , Mary K Nesline , Jeffrey M. Conroy , Paul DePietro , Jason K. Sicklick , Shumei Kato
Background: Glucocorticoid-induced TNFR-related protein (GITR) is a type I transmembrane protein expressed mostly on CD25+CD4+ T-regs and upregulated on all T-cells upon activation. It serves as a T-cell co-stimulatory receptor and its role in cancer treatment is being explored. While pre-clinical data using combination therapies involving GITR agonism showed promise, early clinical trials have not shown improved outcomes to date. Methods: RNA expression levels of 397 genes in 514 patients with a variety of cancer types were assessed and analyzed at OmniSeq. Transcript levels were normalized to internal housekeeping gene profiles and ranked as percentiles using a reference population. High expression was defined as ≥ 75th percentile, and low-moderate as <75th percentile. Univariate p-values were calculated using Welch t-test or Fischer’s exact test. Multivariate p-values were calculated using logistical regression. Results: A total of 99 patients (19.3%) had GITR high expression. Cancers with the highest proportion of GITR high expression were lung (7/20, 35%) and breast (19/49, 39%), and both these cancers showed a statistically significant association with GITR high expression on multivariate analysis (lung: OR 3.5, p = 0.04, 95% confidence interval (CI) 1.06 – 10.06 CI and breast: OR 4.59, p <0.001, 95% CI: 2.11 – 9.85). 30% of lung and 30.6% of breast cancer patients had a GITR high with ligand low-moderate expression profile; these cancers had the highest proportion of patients with this profile. GITR high expression showed significant association with high RNA expression of multiple known immune checkpoint proteins (PD-1, PD-L1, CTLA4, LAG3, OX40, ICOS and CD137, but not TIM3) as well as PD-L1 IHC ≥1 on univariate analysis, but statistically significant association was only seen with PD-L1 IHC ≥1 (p = 0.007) and OX40 high expression (p = 0.001) on multivariate analysis. Conclusions: While clinical trials with GITR agonism are ongoing, our data suggests selection of certain types of malignancies depending on GITR status may be required. Moreover, there is a correlation between high GITR and high OX40 RNA expression, which could imply increased efficacy using this targeted combination. Further clinical development based on this immune-profiling is warranted.
Variable | GITR High n = 99 | GITR Low n = 415 | Univariate p-value | Multivariate OR (95% CI) | Multivariate p-value |
---|---|---|---|---|---|
PD-L1 IHC ≥1 | 47 (47%) | 109 (26%) | <0.001 | 2.22 (1.25 – 3.93) | 0.007 |
PD-1 high | 40 (40%) | 53 (13%) | <0.001 | 1.24 (0.53 – 2.78) | 0.61 |
PD-L1 high | 32 (32%) | 35 (8.4%) | <0.001 | 1.57 (0.71 – 3.38) | 0.26 |
CTLA4 high | 43 (43%) | 44 (11%) | <0.001 | 2.03 (0.93 – 4.44) | 0.077 |
LAG3 high | 45 (45%) | 71 (17%) | <0.001 | 1.63 (0.84 – 3.08) | 0.15 |
OX40 high | 49 (49%) | 73 (18%) | <0.001 | 2.71 (1.49 – 4.88) | 0.001 |
ICOS high | 32 (32%) | 38 (9.2%) | <0.001 | 0.95 (0.38 – 2.24) | 0.9 |
CD137 high | 32 (32%) | 45 (11%) | <0.001 | 1.05 (0.46 – 2.32) | 0.9 |
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