Circulating Tumor DNA Early Kinetics Predict Response of Metastatic Melanoma to Anti-PD1 Immunotherapy: Validation Study

Simple Summary The early detection of primary resistance to anti-PD1 immunotherapies remains a major challenge in the management of metastatic melanoma. In a previous study, we suggested that early monitoring of circulating tumor DNA (ctDNA) using well-defined evaluation criteria allows the identification of primary resistance to anti-PD1 immunotherapies as early as the second week of treatment. We used the same criteria to analyze first-month ctDNA kinetics in a validation cohort. We confirmed that an initial "biological progression" (i.e., a significant increase in ctDNA levels) was an early predictor of a complete lack of clinical benefit under anti-PD1, both in the validation cohort and by pooling the validation and derivation cohorts. Moreover, ctDNA detection at first-line treatment initiation was an independent prognostic factor for overall survival and progression-free survival. The results confirm that early quantitative ctDNA monitoring can detect primary resistance of metastatic melanoma to anti-PD1 immunotherapies. The ability of early (first weeks of treatment) ctDNA kinetics to identify primary resistance to anti-PD1 immunotherapies was evaluated with a validation cohort of 49 patients treated with anti-PD1 for metastatic BRAF or NRAS-mutated melanoma, alone and pooled with the 53 patients from a previously described derivation cohort. BRAF or NRAS mutations were quantified on plasma DNA by digital PCR at baseline and after two or four weeks of treatment. ctDNA kinetics were interpreted according to pre-established biological response criteria. A biological progression (bP, i.e., a significant increase in ctDNA levels) at week two or week four was associated with a lack of benefit from anti-PD1 (4-month PFS = 0%; 1-year OS = 13%; n = 12/102). Patients without initial bP had significantly better PFS and OS (4-month PFS = 78%; 1-year OS = 73%; n = 26/102), as did patients whose ctDNA kinetics were not evaluable, due to low/undetectable baseline ctDNA (4-month PFS = 80%; 1-year OS = 81%; n = 64/102). ctDNA detection at first-line anti-PD1 initiation was an independent prognostic factor for OS and PFS in multivariate analysis. Overall, early ctDNA quantitative monitoring may allow the detection of primary resistances of metastatic melanoma to anti-PD1 immunotherapies.