Dynamics of tumor and immune responses during immune checkpoint blockade in non-small cell lung cancer Journal Article

Authors: Anagnostou, V.; Forde, P. M.; White, J. R.; Niknafs, N.; Hruban, C.; Naidoo, J.; Marrone, K.; Sivakumar, I. K. A.; Bruhm, D. C.; Rosner, S.; Phallen, J.; Leal, A.; Adleff, V.; Smith, K. N.; Cottrell, T. R.; Rhymee, L.; Palsgrove, D. N.; Hann, C. L.; Levy, B.; Feliciano, J.; Georgiades, C.; Verde, F.; Illei, P.; Li, Q. K.; Gabrielson, E.; Brock, M. V.; Isbell, J. M.; Sauter, J. L.; Taube, J.; Scharpf, R. B.; Karchin, R.; Pardoll, D. M.; Chaft, J. E.; Hellmann, M. D.; Brahmer, J. R.; Velculescu, V. E.
Article Title: Dynamics of tumor and immune responses during immune checkpoint blockade in non-small cell lung cancer
Abstract: Despite the initial successes of immunotherapy, there is an urgent clinical need for molecular assays that identify patients more likely to respond. Here, we report that ultrasensitive measures of circulating tumor DNA (ctDNA) and T-cell expansion can be used to assess responses to immune checkpoint blockade in metastatic lung cancer patients (N = 24). Patients with clinical response to therapy had a complete reduction in ctDNA levels after initiation of therapy, whereas nonresponders had no significant changes or an increase in ctDNA levels. Patients with initial response followed by acquired resistance to therapy had an initial drop followed by recrudescence in ctDNA levels. Patients without a molecular response had shorter progression-free and overall survival compared with molecular responders [5.2 vs. 14.5 and 8.4 vs. 18.7 months; HR 5.36; 95% confidence interval (CI), 1.57-18.35; P = 0.007 and HR 6.91; 95% CI, 1.37-34.97; P = 0.02, respectively], which was detected on average 8.7 weeks earlier and was more predictive of clinical benefit than CT imaging. Expansion of T cells, measured through increases of T-cell receptor productive frequencies, mirrored ctDNA reduction in response to therapy. We validated this approach in an independent cohort of patients with early-stage non-small cell lung cancer (N = 14), where the therapeutic effect was measured by pathologic assessment of residual tumor after anti-PD1 therapy. Consistent with our initial findings, early ctDNA dynamics predicted pathologic response to immune checkpoint blockade. These analyses provide an approach for rapid determination of therapeutic outcomes for patients treated with immune checkpoint inhibitors and have important implications for the development of personalized immune targeted strategies.Significance: Rapid and sensitive detection of circulating tumor DNA dynamic changes and T-cell expansion can be used to guide immune targeted therapy for patients with lung cancer.See related commentary by Zou and Meyerson, p. 1038. ©2018 American Association for Cancer Research.
Journal Title: Cancer Research
Volume: 79
Issue: 6
ISSN: 0008-5472
Publisher: American Association for Cancer Research  
Date Published: 2019-03-15
Start Page: 1214
End Page: 1225
Language: English
DOI: 10.1158/0008-5472.Can-18-1127
PUBMED: 30541742
PROVIDER: scopus
PMCID: PMC6432636
Notes: Source: Scopus
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MSK Authors
  1. Jamie Erin Chaft
    136 Chaft
  2. Matthew David Hellmann
    188 Hellmann
  3. James Michael Isbell
    33 Isbell
  4. Jennifer Lynn Sauter
    22 Sauter