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Denize T, Jegede OA, Matar S, El Ahmar N, West DJ, Walton E, Bagheri AS, Savla V, Laimon YN, Gupta S, Vemula SV, Braun DA, Burke KP, Catalano PJ, Freeman GJ, Motzer RJ, Atkins MB, McDermott DF, Sharpe AH, Choueiri TK, Signoretti S. PD-1 Expression on Intratumoral Regulatory T Cells Is Associated with Lack of Benefit from Anti-PD-1 Therapy in Metastatic Clear-Cell Renal Cell Carcinoma Patients. Clin Cancer Res 2024; 30:803-813. [PMID: 38060202 PMCID: PMC10922154 DOI: 10.1158/1078-0432.ccr-23-2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/24/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Programmed cell death protein 1 (PD-1) expression on CD8+TIM-3-LAG-3- tumor-infiltrating cells predicts positive response to PD-1 blockade in metastatic clear-cell renal cell carcinoma (mccRCC). Because inhibition of PD-1 signaling in regulatory T cells (Treg) augments their immunosuppressive function, we hypothesized that PD-1 expression on tumor-infiltrating Tregs would predict resistance to PD-1 inhibitors. EXPERIMENTAL DESIGN PD-1+ Tregs were phenotyped using multiparametric immunofluorescence in ccRCC tissues from the CheckMate-025 trial (nivolumab: n = 91; everolimus: n = 90). Expression of CD8, PD-1, TIM-3, and LAG-3 was previously determined (Ficial and colleagues, 2021). Clinical endpoints included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS In the nivolumab (but not everolimus) arm, high percentage of PD-1+ Tregs was associated with shorter PFS (3.19 vs. 5.78 months; P = 0.021), shorter OS (18.1 vs. 27.7 months; P = 0.013) and marginally lower ORR (12.5% vs. 31.3%; P = 0.059). An integrated biomarker (PD-1 Treg/CD8 ratio) was developed by calculating the ratio between percentage of PD-1+Tregs (marker of resistance) and percentage of CD8+PD-1+TIM-3-LAG-3- cells (marker of response). In the nivolumab (but not everolimus) arm, patients with high PD-1 Treg/CD8 ratio experienced shorter PFS (3.48 vs. 9.23 months; P < 0.001), shorter OS (18.14 vs. 38.21 months; P < 0.001), and lower ORR (15.69% vs. 40.00%; P = 0.009). Compared with the individual biomarkers, the PD-1 Treg/CD8 ratio showed improved ability to predict outcomes to nivolumab versus everolimus. CONCLUSIONS PD-1 expression on Tregs is associated with resistance to PD-1 blockade in mccRCC, suggesting that targeting Tregs may synergize with PD-1 inhibition. A model that integrates PD-1 expression on Tregs and CD8+TIM-3-LAG-3- cells has higher predictive value.
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Affiliation(s)
- Thomas Denize
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Opeyemi A. Jegede
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA
| | - Sayed Matar
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Nourhan El Ahmar
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Destiny J. West
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | - Emily Walton
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | | | - Varunika Savla
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | - Yasmin Nabil Laimon
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | | | | | - David A. Braun
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
- Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine; New Haven, CT
| | - Kelly P. Burke
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Department of Immunology, Blavatnik Institute, Harvard Medical School; Boston, MA
| | - Paul J. Catalano
- Harvard Medical School; Boston, MA
- Department of Biostatistics, Harvard School of Public Health; Boston, MA
| | - Gordon J. Freeman
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
| | - Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY
| | | | - David F. McDermott
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Beth Israel Deaconess Medical Center; Boston, MA
| | - Arlene H. Sharpe
- Harvard Medical School; Boston, MA
- Department of Immunology, Blavatnik Institute, Harvard Medical School; Boston, MA
| | - Toni K. Choueiri
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute; Boston, MA
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