Metastatic site and clinical outcome of patients with deficient mismatch repair metastatic colorectal cancer treated with an immune checkpoint inhibitor in the first-line setting.

Authors

null

Bahar Saberzadeh Ardestani

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

Organizations

Mayo Clinic, Rochester, MN, Mayo Clinic, Jacksonville, FL, University of Poitiers Medical School, Poitiers, France, Department of Oncology, Mayo Clinic Rochester, Rochester, MN, C. H. U. DE TOULOUSE, Toulouse, France, Department of Medical Oncology, Mayo Clinic Rochester, Rochester, MN, Paris-Cité University, Paris, France, Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, Toulouse Hospital University, Toulouse, France, Mayo Clinic, Phoenix, AZ, Mayo Clinic Health System, La Crosse, WI, Division of Medical Oncology, Mayo Clinic, Rochester, MN, Paris Cité University, Paris, France, Mayo Clinic College of Medicine, Rochester, MN

Research Funding

No funding sources reported

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.

Association of liver metastasis with progression-free survival after adjustment for covariates in the validation cohort (n=65, events=19) and in a pooled analysis (n=99, events=37).

VariableValidation Cohort
HR (95% CI)
P-valuePooled Analysis
HR (95% CI)
P-value
Metastasis site
(liver vs non-liver)
2.82 (1.08, 7.39)0.033.18 (1.52, 6.67)0.002
Age
(> 65 vs < 65 yrs)
1.24 (0.46, 3.30)0.661.37 (0.83, 3.72)0.41
Sex
(male vs female)
1.76 (0.68, 4.56)0.241.76 (0.83, 3.72)0.14
Primary tumor site
(right vs left)
1.44 (0.43, 4.82)0.552.34 (0.95, 5.79)0.07
Performance status
(0,1 vs > 2)
1.53 (0.36, 6.64)0.561.33 (0.52, 3.41)0.55
# of metastatic sites
(1 unit)
1.60 (0.86, 2.99)0.141.19 (0.86, 1.65)0.28

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Abstract Details

Meeting

2024 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Patient-Reported Outcomes and Real-World Evidence

Citation

J Clin Oncol 42, 2024 (suppl 3; abstr 55)

DOI

10.1200/JCO.2024.42.3_suppl.55

Abstract #

55

Poster Bd #

D18

Abstract Disclosures