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Ziranu P, Pretta A, Pozzari M, Maccioni A, Badiali M, Fanni D, Lai E, Donisi C, Persano M, Gerosa C, Puzzoni M, Bardanzellu F, Ambu R, Pusceddu V, Dubois M, Cerrone G, Migliari M, Murgia S, Spanu D, Pretta G, Aimola V, Balconi F, Murru S, Faa G, Scartozzi M. CDX-2 expression correlates with clinical outcomes in MSI-H metastatic colorectal cancer patients receiving immune checkpoint inhibitors. Sci Rep 2023; 13:4397. [PMID: 36928082 PMCID: PMC10020482 DOI: 10.1038/s41598-023-31538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) showed efficacy in metastatic colorectal cancer (mCRC) with mismatch-repair deficiency or high microsatellite instability (dMMR-MSI-H). Unfortunately, a patient's subgroup did not benefit from immunotherapy. Caudal-related homeobox transcription factor 2 (CDX-2) would seem to influence immunotherapy's sensitivity, promoting the chemokine (C-X-C motif) ligand 14 (CXCL14) expression. Therefore, we investigated CDX-2 role as a prognostic-predictive marker in patients with mCRC MSI-H. We retrospectively collected data from 14 MSI-H mCRC patients treated with ICIs between 2019 and 2021. The primary endpoint was the 12-month progression-free-survival (PFS) rate. The secondary endpoints were overall survival (OS), PFS, objective response rate (ORR), and disease control rate (DCR). The PFS rate at 12 months was 81% in CDX-2 positive patients vs 0% in CDX-2 negative patients (p = 0.0011). The median PFS was not reached (NR) in the CDX-2 positive group versus 2.07 months (95%CI 2.07-10.8) in CDX-2 negative patients (p = 0.0011). Median OS was NR in CDX-2-positive patients versus 2.17 months (95% Confidence Interval [CI] 2.17-18.7) in CDX2-negative patients (p = 0.026). All CDX-2-positive patients achieved a disease response, one of them a complete response. Among CDX-2-negative patients, one achieved stable disease, while the other progressed rapidly (ORR: 100% vs 0%, p = 0.0005; DCR: 100% vs 50%, p = 0.02). Twelve patients received 1st-line pembrolizumab (11 CDX-2 positive and 1 CDX-2 negative) not reaching median PFS, while two patients (1 CDX-2 positive and 1 CDX-2 negative) received 3rd-line pembrolizumab reaching a median PFS of 10.8 months (95% CI, 10.8-12.1; p = 0.036). Although our study reports results on a small population, the prognostic role of CDX-2 in CRC seems confirmed and could drive a promising predictive role in defining the population more sensitive to immunotherapy treatment. Modulating the CDX-2/CXCL14 axis in CDX-2-negative patients could help overcome primary resistance to immunotherapy.
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Affiliation(s)
- Pina Ziranu
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Andrea Pretta
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Marta Pozzari
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Antonio Maccioni
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Manuela Badiali
- Genetic and Genomic Laboratory, Pediatric Children Hospital A. Cao ASL8, Cagliari, Italy
| | - Daniela Fanni
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Eleonora Lai
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Mara Persano
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Clara Gerosa
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Marco Puzzoni
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Fabio Bardanzellu
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Rossano Ambu
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Valeria Pusceddu
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Marco Dubois
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Giulia Cerrone
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Marco Migliari
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Sara Murgia
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Dario Spanu
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Gianluca Pretta
- Science Department, King's School Hove, Hangleton Way, Hove, BN3 8BN, UK
| | - Valentina Aimola
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesca Balconi
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy
| | - Stefania Murru
- Genetic and Genomic Laboratory, Pediatric Children Hospital A. Cao ASL8, Cagliari, Italy
| | - Gavino Faa
- Division of Pathology, Department of Medical Sciences and Public Health, University Hospital and University of Cagliari, Cagliari, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, SS 554 km 4500 Bivio Per Sestu, 09042, Monserrato, Cagliari, Italy.
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