Implications of GITR expression profile for precision immunotherapeutics.

Authors

null

Peter Moussa

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

Organizations

University of California San Diego, Moores Cancer Center, La Jolla, CA, Medical College of Wisconsin and WIN Consortium, Milwaukee, WI, Dartmouth Cancer Center, Lebanon, NH, OmniSeq (Labcorp), Buffalo, NY, OmniSeq Inc. (Labcorp), Buffalo, NY, Division of Surgical Oncology, Department of Surgery, Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, CA

Research Funding

No funding received
None.

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.

VariableGITR High
n = 99
GITR Low
n = 415
Univariate p-valueMultivariate OR (95% CI)Multivariate p-value
PD-L1 IHC ≥147 (47%)109 (26%)<0.0012.22 (1.25 – 3.93)0.007
PD-1 high40 (40%)53 (13%)<0.0011.24 (0.53 – 2.78)0.61
PD-L1 high32 (32%)35 (8.4%)<0.0011.57 (0.71 – 3.38)0.26
CTLA4 high43 (43%)44 (11%)<0.0012.03 (0.93 – 4.44)0.077
LAG3 high45 (45%)71 (17%)<0.0011.63 (0.84 – 3.08)0.15
OX40 high49 (49%)73 (18%)<0.0012.71 (1.49 – 4.88)0.001
ICOS high32 (32%)38 (9.2%)<0.0010.95 (0.38 – 2.24)0.9
CD137 high32 (32%)45 (11%)<0.0011.05 (0.46 – 2.32)0.9

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Developmental Therapeutics—Immunotherapy

Track

Developmental Therapeutics—Immunotherapy

Sub Track

Immunobiology

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e14561)

DOI

10.1200/JCO.2023.41.16_suppl.e14561

Abstract #

e14561

Abstract Disclosures

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