Gene expression profile of high PD-L1 non-small cell lung cancers refractory to pembrolizumab.

Cancer Immunol Immunother

Department of Pulmonary Diseases and Thoracic Oncology, APHP - Hopital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.

Published: November 2022

AI Article Synopsis

  • Despite high levels of PD-L1, about 50% of patients with advanced non-small cell lung cancer (NSCLC) do not respond to the immunotherapy drug pembrolizumab, highlighting the need to investigate potential resistance mechanisms.
  • A study analyzed patients with advanced NSCLC who had high PD-L1 expression and were treated with pembrolizumab, which found that about half experienced early tumor progression, mainly among those with poor health status and low albumin levels.
  • Gene expression analysis revealed distinct clusters of tumors, with one cluster showing increased activation of stemness-associated pathways and reduced activity in immune response pathways, suggesting potential reasons for treatment resistance.

Article Abstract

Background: Despite high expression of PD-L1, around half of advanced non-small cell lung cancer (NSCLC) will not experience tumor response with pembrolizumab. There is an need for a better understanding of the resistance mechanisms in this setting.

Methods: This bi-centric retrospective study included all consecutive patients with PDL1 ≥ 50% advanced NSCLC treated with pembrolizumab in first-line treatment between 2016 and 2020. We compared the clinical characteristics of patients with early progression (refractory) vs others. We performed a comprehensive gene expression profile screening by RNAseq capture on tumor samples.

Results: We included 46 patients. Twenty-two patients were refractory to pembrolizumab, mainly women, with poor performance status and lower albumin concentration. RNAseq analysis was performed on 19 samples. Hierarchical clustering allowed the identification of 3 clusters with various proportion of refractory tumors: intermediate (C1: 57%), high (C2: 71%) and low proportion (C3: 40%). Comparative analysis between C2 and C3 allowed the identification of overexpressed (n = 137) and underexpressed (n = 40) genes. Among the genes of interest, C2 exhibits higher activation of pathways associated with stemness phenotype (Hedgehog, Notch and Hippo pathways) and pathways associated with loss of PTEN and JAK2. In C2, genes associated with PD-1, toll-like receptor-9 (TLR-9), major histocompatibility complex (MHC) and interferon-γ pathways were underexpressed.

Conclusion: This study gives an overview of activated and downregulated pathways in high PD-L1 NSCLC refractory to pembrolizumab. These tumors showed activation of pathways associated with cancer stem cells, loss of PTEN and JAK2, and inhibition of both priming and effector phases of the immune response.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10992407PMC
http://dx.doi.org/10.1007/s00262-022-03206-4DOI Listing

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