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Skoulidis F, Goldberg ME, Greenawalt DM, Hellmann MD, Awad MM, Gainor JF, Schrock AB, Hartmaier RJ, Trabucco SE, Gay L, Ali SM, Elvin JA, Singal G, Ross JS, Fabrizio D, Szabo PM, Chang H, Sasson A, Srinivasan S, Kirov S, Szustakowski J, Vitazka P, Edwards R, Bufill JA, Sharma N, Ou SHI, Peled N, Spigel DR, Rizvi H, Aguilar EJ, Carter BW, Erasmus J, Halpenny DF, Plodkowski AJ, Long NM, Nishino M, Denning WL, Galan-Cobo A, Hamdi H, Hirz T, Tong P, Wang J, Rodriguez-Canales J, Villalobos PA, Parra ER, Kalhor N, Sholl LM, Sauter JL, Jungbluth AA, Mino-Kenudson M, Azimi R, Elamin YY, Zhang J, Leonardi GC, Jiang F, Wong KK, Lee JJ, Papadimitrakopoulou VA, Wistuba II, Miller VA, Frampton GM, Wolchok JD, Shaw AT, Jänne PA, Stephens PJ, Rudin CM, Geese WJ, Albacker LA, Heymach JV. STK11/LKB1 Mutations and PD-1 Inhibitor Resistance in KRAS-Mutant Lung Adenocarcinoma. Cancer Discov 2018; 8:822-835. [PMID: 29773717 DOI: 10.1158/2159-8290.cd-18-0099] [Citation(s) in RCA: 1013] [Impact Index Per Article: 168.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/29/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022]
Abstract
KRAS is the most common oncogenic driver in lung adenocarcinoma (LUAC). We previously reported that STK11/LKB1 (KL) or TP53 (KP) comutations define distinct subgroups of KRAS-mutant LUAC. Here, we examine the efficacy of PD-1 inhibitors in these subgroups. Objective response rates to PD-1 blockade differed significantly among KL (7.4%), KP (35.7%), and K-only (28.6%) subgroups (P < 0.001) in the Stand Up To Cancer (SU2C) cohort (174 patients) with KRAS-mutant LUAC and in patients treated with nivolumab in the CheckMate-057 phase III trial (0% vs. 57.1% vs. 18.2%; P = 0.047). In the SU2C cohort, KL LUAC exhibited shorter progression-free (P < 0.001) and overall (P = 0.0015) survival compared with KRASMUT;STK11/LKB1WT LUAC. Among 924 LUACs, STK11/LKB1 alterations were the only marker significantly associated with PD-L1 negativity in TMBIntermediate/High LUAC. The impact of STK11/LKB1 alterations on clinical outcomes with PD-1/PD-L1 inhibitors extended to PD-L1-positive non-small cell lung cancer. In Kras-mutant murine LUAC models, Stk11/Lkb1 loss promoted PD-1/PD-L1 inhibitor resistance, suggesting a causal role. Our results identify STK11/LKB1 alterations as a major driver of primary resistance to PD-1 blockade in KRAS-mutant LUAC.Significance: This work identifies STK11/LKB1 alterations as the most prevalent genomic driver of primary resistance to PD-1 axis inhibitors in KRAS-mutant lung adenocarcinoma. Genomic profiling may enhance the predictive utility of PD-L1 expression and tumor mutation burden and facilitate establishment of personalized combination immunotherapy approaches for genomically defined LUAC subsets. Cancer Discov; 8(7); 822-35. ©2018 AACR.See related commentary by Etxeberria et al., p. 794This article is highlighted in the In This Issue feature, p. 781.
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Affiliation(s)
- Ferdinandos Skoulidis
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Matthew D Hellmann
- Druckenmiller Center for Lung Cancer Research and Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark M Awad
- Lowe Center for Thoracic Oncology and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Justin F Gainor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Laurie Gay
- Foundation Medicine Inc., Cambridge, Massachusetts
| | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, Massachusetts
| | | | | | | | | | | | - Han Chang
- Bristol-Myers Squibb Co., Princeton, New Jersey
| | | | | | | | | | | | | | | | - Neelesh Sharma
- Novartis Institute of Biomedical Research, East Hanover, New Jersey
| | - Sai-Hong I Ou
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, California
| | - Nir Peled
- Thoracic Cancer Unit, Davidoff Cancer Center, Petach Tiqwa, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | - Hira Rizvi
- Druckenmiller Center for Lung Cancer Research and Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Jimenez Aguilar
- Lowe Center for Thoracic Oncology and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niamh M Long
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Warren L Denning
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ana Galan-Cobo
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Haifa Hamdi
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Taghreed Hirz
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pan Tong
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaime Rodriguez-Canales
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela A Villalobos
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin R Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Roxana Azimi
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Yasir Y Elamin
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Giulia C Leonardi
- Lowe Center for Thoracic Oncology and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Fei Jiang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwok-Kin Wong
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vassiliki A Papadimitrakopoulou
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice T Shaw
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Pasi A Jänne
- Lowe Center for Thoracic Oncology and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Charles M Rudin
- Druckenmiller Center for Lung Cancer Research and Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - John V Heymach
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Biton J, Mansuet-Lupo A, Pécuchet N, Alifano M, Ouakrim H, Arrondeau J, Boudou-Rouquette P, Goldwasser F, Leroy K, Goc J, Wislez M, Germain C, Laurent-Puig P, Dieu-Nosjean MC, Cremer I, Herbst R, Blons H, Damotte D. TP53, STK11, and EGFR Mutations Predict Tumor Immune Profile and the Response to Anti-PD-1 in Lung Adenocarcinoma. Clin Cancer Res 2018; 24:5710-5723. [PMID: 29764856 DOI: 10.1158/1078-0432.ccr-18-0163] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/14/2018] [Accepted: 05/10/2018] [Indexed: 01/13/2023]
Abstract
Purpose: By unlocking antitumor immunity, antibodies targeting programmed cell death 1 (PD-1) exhibit impressive clinical results in non-small cell lung cancer, underlining the strong interactions between tumor and immune cells. However, factors that can robustly predict long-lasting responses are still needed.Experimental Design: We performed in-depth immune profiling of lung adenocarcinoma using an integrative analysis based on immunohistochemistry, flow-cytometry, and transcriptomic data. Tumor mutational status was investigated using next-generation sequencing. The response to PD-1 blockers was analyzed from a prospective cohort according to tumor mutational profiles and PD-L1 expression, and a public clinical database was used to validate the results obtained.Results: We showed that distinct combinations of STK11, EGFR, and TP53 mutations were major determinants of the tumor immune profile (TIP) and of the expression of PD-L1 by malignant cells. Indeed, the presence of TP53 mutations without co-occurring STK11 or EGFR alterations (TP53-mut/STK11-EGFR-WT), independently of KRAS mutations, identified the group of tumors with the highest CD8 T-cell density and PD-L1 expression. In this tumor subtype, pathways related to T-cell chemotaxis, immune cell cytotoxicity, and antigen processing were upregulated. Finally, a prolonged progression-free survival (PFS: HR = 0.32; 95% CI, 0.16-0.63, P < 0.001) was observed in anti-PD-1-treated patients harboring TP53-mut/STK11-EGFR-WT tumors. This clinical benefit was even more remarkable in patients with associated strong PD-L1 expression.Conclusions: Our study reveals that different combinations of TP53, EGFR, and STK11 mutations, together with PD-L1 expression by tumor cells, represent robust parameters to identify best responders to PD-1 blockade. Clin Cancer Res; 24(22); 5710-23. ©2018 AACR.
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Affiliation(s)
- Jérôme Biton
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | - Audrey Mansuet-Lupo
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France.,Department of Pathology, Assistance Publique, Hôpitaux de Paris (APHP), Hôpital Cochin, Paris, France
| | - Nicolas Pécuchet
- INSERM UMRS 1147, Paris, France.,Department of Biochemistry, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, APHP, Hôpital Cochin, Paris, France
| | - Hanane Ouakrim
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | | | | | - François Goldwasser
- University Paris Descartes, Paris, France.,Department of Medical Oncology, APHP, Hôpital Cochin, Paris, France
| | - Karen Leroy
- University Paris Descartes, Paris, France.,Department of Genetic and Molecular Biology, APHP, Hôpital Cochin, Paris, France
| | - Jeremy Goc
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | - Marie Wislez
- University Pierre et Marie Curie-Paris, Paris, France.,Department of Respiratory Medicine, APHP, Hôpital Tenon, Paris, France
| | - Claire Germain
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | - Pierre Laurent-Puig
- University Paris Descartes, Paris, France.,INSERM UMRS 1147, Paris, France.,Department of Biochemistry, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie-Caroline Dieu-Nosjean
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | - Isabelle Cremer
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France.,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France
| | - Ronald Herbst
- Oncology Research, MedImmune, LLC, Gaithersburg, Maryland
| | - Hélène Blons
- University Paris Descartes, Paris, France.,INSERM UMRS 1147, Paris, France.,Department of Biochemistry, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Diane Damotte
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France. .,University Paris Descartes, Paris, France.,University Pierre et Marie Curie-Paris, Paris, France.,Department of Pathology, Assistance Publique, Hôpitaux de Paris (APHP), Hôpital Cochin, Paris, France
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