Elucidating the Heterogeneity of Immunotherapy Response and Immune-Related Toxicities by Longitudinal ctDNA and Immune Cell Compartment Tracking in Lung Cancer

被引:9
作者
Murray, Joseph C. [1 ,2 ,3 ]
Sivapalan, Lavanya [1 ]
Hummelink, Karlijn [4 ]
Balan, Archana [1 ]
White, James R. [1 ]
Niknafs, Noushin [1 ]
Rhymee, Lamia [1 ]
Pereira, Gavin [1 ]
Rao, Nisha [1 ]
Weksler, Benny [5 ]
Bahary, Nathan [5 ]
Phallen, Jillian [1 ]
Leal, Alessandro [1 ]
Bartlett, David L. [5 ]
Marrone, Kristen A. [1 ,3 ]
Naidoo, Jarushka [1 ,6 ]
Goel, Akul [7 ]
Levy, Benjamin [1 ]
Rosner, Samuel [1 ]
Hann, Christine L. [1 ]
Scott, Susan C. [1 ]
Feliciano, Josephine [1 ]
Lam, Vincent K. [1 ]
Ettinger, David S. [1 ]
Li, Qing Kay [1 ,8 ]
Illei, Peter B. [1 ,8 ]
Monkhorst, Kim [4 ]
Scharpf, Robert B. [1 ]
Brahmer, Julie R. [1 ,2 ,3 ]
Velculescu, Victor E. [1 ]
Zaidi, Ali H. [5 ]
Forde, Patrick M. [1 ,2 ]
Anagnostou, Valsamo [1 ,2 ,3 ]
机构
[1] Johns Hopkins Univ, Sidney Kimmel Comprehens Canc Ctr, Sch Med, Room 546, Baltimore, MD 21231 USA
[2] Johns Hopkins Univ, Bloomberg Kimmel Inst Canc Immunotherapy, Sch Med, Baltimore, MD 21231 USA
[3] Johns Hopkins Univ, Lung Canc Precis Med Ctr Excellence, Sch Med, Baltimore, MD 21231 USA
[4] Antoni van Leeuwenhoek Nederlands Kanker Inst, Amsterdam, Netherlands
[5] Allegheny Hlth Network, Allegheny Hlth Network Canc Inst, Pittsburgh, PA USA
[6] Beaumont RCSI Canc Ctr, Dublin, Ireland
[7] CALTECH, 1200 E Calif Blvd, Pasadena, CA 91125 USA
[8] Johns Hopkins Univ, Dept Pathol, Baltimore, MD 21231 USA
基金
美国国家卫生研究院;
关键词
ADVERSE EVENTS; TUMOR; DYNAMICS; BLOCKADE; BENEFIT;
D O I
10.1158/1078-0432.CCR-23-1469
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Although immunotherapy is the mainstay of therapy for advanced non-small cell lung cancer (NSCLC), robust biomarkers of clinical response are lacking. The heterogeneity of clinical responses together with the limited value of radiographic response assessments to timely and accurately predict therapeutic effect-especially in the setting of stable disease-calls for the development of molecularly informed real-time minimally invasive approaches. In addition to capturing tumor regression, liquid biopsies may be informative in capturing immune-related adverse events (irAE).Experimental Design: We investigated longitudinal changes in circulating tumor DNA (ctDNA) in patients with metastatic NSCLC who received immunotherapy-based regimens. Using ctDNA targeted error-correction sequencing together with matched sequencing of white blood cells and tumor tissue, we tracked serial changes in cell-free tumor load (cfTL) and determined molecular response. Peripheral T-cell repertoire dynamics were serially assessed and evaluated together with plasma protein expression profiles.Results: Molecular response, defined as complete clearance of cfTL, was significantly associated with progression-free (log-rank P = 0.0003) and overall survival (log-rank P = 0.01) and was particularly informative in capturing differential survival outcomes among patients with radiographically stable disease. For patients who developed irAEs, on-treatment peripheral blood T-cell repertoire reshaping, assessed by significant T-cell receptor (TCR) clonotypic expansions and regressions, was identified on average 5 months prior to clinical diagnosis of an irAE.Conclusions: Molecular responses assist with the interpretation of heterogeneous clinical responses, especially for patients with stable disease. Our complementary assessment of the peripheral tumor and immune compartments provides an approach for monitoring of clinical benefits and irAEs during immunotherapy.
引用
收藏
页码:389 / 403
页数:15
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