Mayo Clinic, Rochester, MN
Bahar Saberzadeh Ardestani , Jeremy Clifton Jones , Robert R. McWilliams , David Tougeron , Thorvardur Ragnar Halfdanarson , Rosine Guimbaud , Joleen M. Hubbard , Clémence Flecchia , Qian Shi , Emily Linda Alouani , Bassam Bassam Sonbol , Jonathan Ticku , Zhaohui Jin , Julien Taieb , Frank A. Sinicrope
Background: Nearly one-half of deficient mismatch repair (d-MMR) metastatic colorectal cancers (mCRC) demonstrate durable responses to immune checkpoint inhibitors (ICIs). Given preclinical data indicating that liver metastases sequester activated CD8+ T cells from systemic circulation, we examined clinical outcome by metastatic site. Methods: In a retrospective cohort of patients with d-MMR mCRCs treated at multiple centers in France (n=66), we sought to validate data from a U.S. cohort, and then performed pooled analysis (n=104). All patients received first-line ICI monotherapy. Metastatic site was analyzed in relationship to tumor response (RECIST version 1.1), and progression-free survival (PFS) by multivariable stratified Cox regression after adjustment for covariates. Results: Objective responses were achieved in 38/66 (58%) patients in the validation cohort. Best tumor response included 13 (20%) complete responses (CR), 25 (38%) partial responses (PR), 16 (25%) stable disease, and 11 (17%) progressive disease (PD). One-year and 5-year PFS rates were 73% and 67%, respectively; 18 (27%) patients progressed during immunotherapy. Best tumor response was attenuated in patients with liver metastasis (P=0.03). Presence of liver metastasis, but not other sites, was associated with significantly poorer PFS after adjustment for covariates (HRadj 2.82; 95%CI, 1.08-7.39; Padj=0.03). In a pooled analysis, liver metastasis remained significantly and independently associated with poorer PFS (HRadj 3.18; 95%CI, 1.52-6.67; Padj=0.002) and with attenuated tumor best response (P=0.01). Conclusions: Metastasis to the liver, but not other sites, was validated as an independent factor associated with poorer response and survival after ICI treatment in d-MMR mCRCs. These data underscore the need for novel therapeutic strategies in these patients.
Variable | Validation Cohort HR (95% CI) | P-value | Pooled Analysis HR (95% CI) | P-value |
---|---|---|---|---|
Metastasis site (liver vs non-liver) | 2.82 (1.08, 7.39) | 0.03 | 3.18 (1.52, 6.67) | 0.002 |
Age (> 65 vs < 65 yrs) | 1.24 (0.46, 3.30) | 0.66 | 1.37 (0.83, 3.72) | 0.41 |
Sex (male vs female) | 1.76 (0.68, 4.56) | 0.24 | 1.76 (0.83, 3.72) | 0.14 |
Primary tumor site (right vs left) | 1.44 (0.43, 4.82) | 0.55 | 2.34 (0.95, 5.79) | 0.07 |
Performance status (0,1 vs > 2) | 1.53 (0.36, 6.64) | 0.56 | 1.33 (0.52, 3.41) | 0.55 |
# of metastatic sites (1 unit) | 1.60 (0.86, 2.99) | 0.14 | 1.19 (0.86, 1.65) | 0.28 |
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