Multiplex analysis of the immune environment before and after neoadjuvant durvalumab as a prognostic factor in resectable non-small cell lung cancer (NSCLC) in the IFCT-1601 IONESCO phase 2 trial.

Authors

null

Diane Damotte

U1138, Centre de Recherche des Cordeliers; Pathology, Hôpital Cochin, Paris, France

Diane Damotte , Yoan Velut , Barbara Burroni , Gary Birsen , Julien Lavergne , Audrey Mansuet-Lupo , Isabelle Cremer , Julien Mazieres , Jacques Cadranel , Gerard Zalcman , Radj Gervais , Gaelle Jeannin , Olivier Molinier , Thomas Egenod , Olivier Carre , Celia Berndt , Alexandra Langlais , Franck Morin , Virginie Westeel , Marie Wislez

Organizations

U1138, Centre de Recherche des Cordeliers; Pathology, Hôpital Cochin, Paris, France, U1138, Centre de Recherche des Cordeliers, Paris, France, Pathology, Hôpital Cochin, Paris, France, Thoracic Oncology Department, Hôpital Larrey, Toulouse, France, Université Paris Sorbonne, Service de Pneumologie et oncologie thoracique, Hôpital Tenon, APHP. Sorbonne Université, Paris, France, Université Paris Cité, Thoracic Oncology Department & CIC Inserm 1425, Hôpital Bichat Claude Bernard, AP-HP.Nord, Paris, France, Pneumology, Centre Francois Baclesse, Caen, France, Thoracic Oncology, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Pneumology, Centre Hospitalier Du Mans, Le Mans, France, Thoracic Oncology, Hopital Dupuytren, Limoges, France, Pneumology, Clinique de l'Europe Amiens, Amiens, France, Clinical Research Unit, French Cooperative Thoracic Intergroup, Paris, France, Biostatistics, French Cooperative Thoracic Intergroup, Paris, France, Pneumology, Hopital Jean Minjoz, Besançon, France, Service de Pneumologie, Hopital Cochin, Assistance Publique – Hôpitaux de Paris, Paris, France

Research Funding

AstraZeneca
Intergroupe Francophone de Cancerologie Thoracique

Background: Immune checkpoint inhibitors (ICI) are currently included in the peri-operative standard of care for NSCLC with the objective of a curative strategy. In early stages of NSCLC, biomarkers predicting ICI efficacy should be more stringent than PD-L1 tumoral expression in order to improve the benefit-toxicity ratio. We deeply analyzed the tumor microenvironment of patients included in the IONESCO multicenter phase 2 trial (stage IB > 4cm–IIIA, non N2 resectable NSCLC). Diagnostic biopsies and surgical resection specimen after 3 cycles of Durvalumab were available. We previously showed that the % of residual viable tumor cells (RVT) was associated with disease free survival (DFS) and overall survival (OS). PD-L1 tumor positive score was not correlated to RVT nor survival. Methods: 46 patients were included in the IONESCO trial. Among them, diagnostic biopsy (n = 32), surgical resection specimen post durvalumab (n = 39) and paired tumor samples (n = 31) were analyzed. Immune environment was assessed using 7 quantitative 7-plex immunofluorescence panels generating 349 different cellular phenotypes in 3 different compartments (whole tumor, intra cytokeratin and stroma), focusing on T and B lymphocytes, macrophages, immune checkpoint, NK cells, apoptosis, innate and adaptive immunity, dendritic cells. Densities of cells were quantified using Fluorescent Multiplex immunohistochemistry performed on Leica Bond RX, using OpalTM technology. A fisher's exact test or chi2 test was used for demographics variables and RVT. HRs and 95% CIs were estimated using a Cox model. NCT number: NCT03030131. Results: With median follow-up of 4.5 years, 16/31 patients had a disease recurrence. Histology, sex, stage and survival were significantly associated with intra-tumor densities of CD3, CD8, PD1, TIM3, and CD163 cells in the diagnostic biopsy, and with the delta of CD3, FoxP3, CD4, CD163PD1, TIM3, PDL1 on immune cells and TIM3PDL1 cells, between biopsy and surgical specimen. DFS was significantly associated with high density of CD8+TIM3+ in biopsies (HR = 0.25 [0.09-0.71], p = 0.0092) and with the high density of CD20+ cells in surgical specimen (HR = 0.36 [0.13-0.97], p = 0.04). The RVT was significantly associated with CK+Caspase3- cells and CK+PDL1+ cells in the surgical specimen. No biomarker was associated with OS. Conclusions: Multiparameter analysis of the immune NSCLC environment of patients treated with neoadjuvant anti-PDL1 allows identification of markers associated with clinical, pathological parameters and DFS. Our findings highlight the substantial impact of high CD8+TIM3+ cell density pre-durvalumab and of high CD20+ cell density post-durvalumab on DFS. These findings deserve to be assessed in patients treated with neoadjuvant combined immunotherapy chemotherapy. Clinical trial information: NCT03030131.

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Abstract Details

Meeting

2024 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Adjuvant Therapy

Clinical Trial Registration Number

NCT03030131

Citation

J Clin Oncol 42, 2024 (suppl 16; abstr 8022)

DOI

10.1200/JCO.2024.42.16_suppl.8022

Abstract #

8022

Poster Bd #

284

Abstract Disclosures