Tumor microenvironment gene expression profiles associated to complete pathological response and disease progression in resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy

Abstract

BackgroundNeoadjuvant chemoimmunotherapy for non-small cell lung cancer (NSCLC) has improved pathological responses and survival rates compared with chemotherapy alone, leading to Food and Drug Administration (FDA) approval of nivolumab plus chemotherapy for resectable stage IB-IIIA NSCLC (AJCC 7th edition) without ALK or EGFR alterations. Unfortunately, a considerable percentage of tumors do not completely respond to therapy, which has been associated with early disease progression. So far, it is impossible to predict these events due to lack of knowledge. In this study, we characterized the gene expression profile of tumor samples to identify new biomarkers and mechanisms behind tumor responses to neoadjuvant chemoimmunotherapy and disease recurrence after surgery.MethodsTumor bulk RNA sequencing was performed in 16 pretreatment and 36 post-treatment tissue samples from 41 patients with resectable stage IIIA NSCLC treated with neoadjuvant chemoimmunotherapy from NADIM trial. A panel targeting 395 genes related to immunological processes was used. Tumors were classified as complete pathological response (CPR) and non-CPR, based on the total absence of viable tumor cells in tumor bed and lymph nodes tested at surgery. Differential-expressed genes between groups and pathway enrichment analysis were assessed using DESeq2 and gene set enrichment analysis. CIBERSORTx was used to estimate the proportions of immune cell subtypes.ResultsCPR tumors had a stronger pre-established immune infiltrate at baseline than non-CPR, characterized by higher levels of IFNG, GZMB, NKG7, and M1 macrophages, all with a significant area under the receiver operating characteristic curve (ROC) >0.9 for CPR prediction. A greater effect of neoadjuvant therapy was also seen in CPR tumors with a reduction of tumor markers and IFNγ signaling after treatment. Additionally, the higher expression of several genes, including AKT1, BST2, OAS3, or CD8B; or higher dendritic cells and neutrophils proportions in post-treatment non-CPR samples, were associated with relapse after surgery. Also, high pretreatment PD-L1 and tumor mutational burden levels influenced the post-treatment immune landscape with the downregulation of proliferation markers and type I interferon signaling molecules in surgery samples.ConclusionsOur results reinforce the differences between CPR and non-CPR responses, describing possible response and relapse immune mechanisms, opening the possibility of therapy personalization of immunotherapy-based regimens in the neoadjuvant setting of NSCLC.

Progress on neoadjuvant immunotherapy in resectable non-small cell lung cancer and potential biomarkers

“…Previous study ( 72 ) found that APOBEC signature in metastatic NSCLC is strongly associated with better immune responses, in terms of ORR and PFS. Tumor bulk RNA sequencing in NADIM trial recently revealed that certain tumor environmental gene expression could predict pCR with the AUC >0.9 ( 73 ). With innovational technique implying in this area, novel markers including mutational signature ( 74 , 75 ), intestinal microbiota ( 76 ), radiomics ( 77 , 78 ) are now under analysis in neoadjuvant setting of NSCLC, with the hope to provide us with a deeper understanding of the tumor environment and evolution.…”

Complete response of recurrent perihilar cholangiocarcinoma following sintilimab combined with lenvatinib plus S-1: a case report and review of literature

“…A considerable number of clinical trials have demonstrated that combined therapy might improve anticancer efficacy by modifying the tumor microenvironment to improve the delivery of antitumor agents [20,21].…”

Immunotherapy in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Current Evidence and Perspectives

“…The molecular and immunological bases responsible for sensitivity or resistance remain to be fully determined; however, emerging biomarkers have been described. In order to identify molecular markers for patient selection, tumor samples from patients enrolled in the NADIM study were analyzed [ 27 ]. Results showed a pro-inflammatory gene expression profile, a higher T cell receptor repertoire clonality and the upregulation of genes involved in the signaling pathway of IFN-γ in pretreatment tissues of those patients obtaining pCR.…”