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Zaretsky JM, Garcia-Diaz A, Shin DS, Escuin-Ordinas H, Hugo W, Hu-Lieskovan S, Torrejon DY, Abril-Rodriguez G, Sandoval S, Barthly L, Saco J, Homet Moreno B, Mezzadra R, Chmielowski B, Ruchalski K, Shintaku IP, Sanchez PJ, Puig-Saus C, Cherry G, Seja E, Kong X, Pang J, Berent-Maoz B, Comin-Anduix B, Graeber TG, Tumeh PC, Schumacher TNM, Lo RS, Ribas A. Mutations Associated with Acquired Resistance to PD-1 Blockade in Melanoma. N Engl J Med 2016; 375:819-29. [PMID: 27433843 PMCID: PMC5007206 DOI: 10.1056/nejmoa1604958] [Citation(s) in RCA: 2231] [Impact Index Per Article: 278.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately 75% of objective responses to anti-programmed death 1 (PD-1) therapy in patients with melanoma are durable, lasting for years, but delayed relapses have been noted long after initial objective tumor regression despite continuous therapy. Mechanisms of immune escape in this context are unknown. METHODS We analyzed biopsy samples from paired baseline and relapsing lesions in four patients with metastatic melanoma who had had an initial objective tumor regression in response to anti-PD-1 therapy (pembrolizumab) followed by disease progression months to years later. RESULTS Whole-exome sequencing detected clonal selection and outgrowth of the acquired resistant tumors and, in two of the four patients, revealed resistance-associated loss-of-function mutations in the genes encoding interferon-receptor-associated Janus kinase 1 (JAK1) or Janus kinase 2 (JAK2), concurrent with deletion of the wild-type allele. A truncating mutation in the gene encoding the antigen-presenting protein beta-2-microglobulin (B2M) was identified in a third patient. JAK1 and JAK2 truncating mutations resulted in a lack of response to interferon gamma, including insensitivity to its antiproliferative effects on cancer cells. The B2M truncating mutation led to loss of surface expression of major histocompatibility complex class I. CONCLUSIONS In this study, acquired resistance to PD-1 blockade immunotherapy in patients with melanoma was associated with defects in the pathways involved in interferon-receptor signaling and in antigen presentation. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Jesse M Zaretsky
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Angel Garcia-Diaz
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Daniel S Shin
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Helena Escuin-Ordinas
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Willy Hugo
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Siwen Hu-Lieskovan
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Davis Y Torrejon
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Gabriel Abril-Rodriguez
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Salemiz Sandoval
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Lucas Barthly
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Justin Saco
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Blanca Homet Moreno
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Riccardo Mezzadra
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Bartosz Chmielowski
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Kathleen Ruchalski
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - I Peter Shintaku
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Phillip J Sanchez
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Cristina Puig-Saus
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Grace Cherry
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Elizabeth Seja
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Xiangju Kong
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Jia Pang
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Beata Berent-Maoz
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Begoña Comin-Anduix
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Thomas G Graeber
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Paul C Tumeh
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Ton N M Schumacher
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Roger S Lo
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
| | - Antoni Ribas
- From the University of California, Los Angeles (UCLA) (J.M.Z., A.G.-D., D.S.S., H.E.-O., W.H., S.H.-L., D.Y.T., G.A.-R., S.S., L.B., J.S., B.H.M., B.C., K.R., I.P.S., P.J.S., C.P.-S., G.C., E.S., X.K., J.P., B.B.-M., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.), and Jonsson Comprehensive Cancer Center (B.C., B.C.-A., T.G.G., P.C.T., R.S.L., A.R.) - both in Los Angeles; and the Division of Immunology, Netherlands Cancer Institute, Amsterdam (R.M., T.N.M.S.)
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