PD-L1 and PD-L2 Expression in Cervical Cancer: Regulation and Biomarker Potential

The recurrences of cervical cancer: Possibilities of molecular prediction

The incidence of recurrence of cervical cancer ranges from 10 to 40 %. The 5-year survival rate for patients with recurrent cervical cancer is about 5–15 % against the background of current drug therapy. Clinical and morphological characteristics of the tumor process are known, which are used as markers of an unfavorable prognosis for the development of cervical cancer recurrence. The search for molecular prognostic markers of the course of cervical cancer continues.

The aim. To determine the level of immune cycle proteins in patients with cervical cancer 0–IV stages, depending on the occurrence of a relapse of the disease.

Materials and research methods. A retrospective analysis of previously obtained results of a study on the local level of immune cycle proteins in patients with cervical cancer was performed. Three years after follow-up, 2 groups were formed: group 1 – patients treated for cervical cancer without signs of disease progression (n = 83); group 2 – patients with cervical cancer with local or systemic recurrence (n = 18). Used statistical methods: non-parametric methods of statistics using the Kruskal – Wallis test; ROC-analysis for significant values in order to calculate threshold values; determination of the quality of the identified predictive markers by calculating the sensitivity, specificity, accuracy.

Results. Local initial threshold values have a predictive value for predicting the occurrence of cervical cancer recurrence: B7.2 < 10.7 pg/ml (Se = 0.87; Sp = 0.73; Ac = 0.76; AUC = 0.78), PD-L1 ≤ 5.1 pg/ml (Se = 0.87; Sp = 0.68; Ac = 0.71; AUC = 0.76), sCD27 ≥ 32.0 pg/ml (Se = 0.75; Sp = 0.78; Ac = 0.78; AUC = 0.75).

Conclusion. Determination of local levels of B7.2, PD-L1, sCD27 in patients with cervical cancer before treatment can be used to predict the development of disease recurrence during 3 years of follow-up.

Cutaneous metastasis of PD-L1 positive cervical carcinoma

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Cutaneous metastases in cervical cancer are rare and associated with a poor prognosis.

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Treatment is typically palliative, utilizing chemotherapy and radiation.

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We report a case of PD-L1 positive cervical cancer with cutaneous metastases that developed after initial recurrence.

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For patients on checkpoint inhibitor therapy who develop skin toxicity, it is important to rule out cutaneous metastases.

Immune correlates of clinical parameters in patients with HPV-associated malignancies treated with bintrafusp alfa

Purpose

Bintrafusp alfa is a bifunctional agent consisting of an anti-human PD-L1 antibody linked to two TGFβRII. It is designed to act both as a checkpoint inhibitor and to ‘trap’ TGFβ in the tumor microenvironment. Phase I and II clinical studies demonstrated clinical activity in patients with a range of human papillomavirus (HPV)-associated cancers. The purpose of the studies reported here was the interrogation of various aspects of the peripheral immunome in patients with HPV-associated cancers, both prior to and early in the treatment regimen of bintrafusp alfa to better understand the mode of action of the agent and to help define which patients are more likely to benefit from bintrafusp alfa treatment.

Patients and methods

The peripheral immunome of patients (n=65) with HPV⁺ malignancies was analyzed both prior to treatment with bintrafusp alfa and day 14 post-treatment for levels and changes in (1) 158 different immune cell subsets, (2) multiple plasma soluble factors including analytes reflecting immune stimulatory and inhibitory status, (3) complete blood counts, and in a subset of patients (4) TCR diversity and (5) HPV-specific T-cell responses.

Results

Interrogation of the peripheral immunome prior to bintrafusp alfa treatment revealed several factors that associated with clinical response, including (1) higher levels of sCD27:sCD40L ratios, (2) lower levels of TGFβ1 and 12 additional factors associated with tumor mesenchymalization, and (3) higher CD8⁺ T cell:MDSC ratios. Analysis at 2 weeks post bintrafusp alfa revealed that eventual clinical responders had fewer increases in IL-8 levels and the neutrophil to lymphocyte ratio, and higher levels of HPV-16 specific CD8⁺ T cells. This study also provided information concerning differences in the peripheral immunome for patients who were naïve versus refractory to prior checkpoint inhibition therapy. While preliminary, two multivariate models developed predicted clinical benefit with 76%–91% accuracy.

Conclusions

These studies add insight into the mechanism of action of bintrafusp alfa and provide evidence that the interrogation of both cellular and soluble components of the peripheral immunome of patients with HPV-associated malignancies, either prior to or early in the therapeutic regimen, can provide information as to which patients are more likely to benefit with bintrafusp alfa therapy.

CircFOXK2 enhances tumorigenesis and immune evasion in non-small cell lung cancer by miR-485-5p/PD-L1 axis

BACKGROUND

Circular RNAs (circRNAs) serve a key role in lots of cancers. The outcomes of upregulated circular RNA forkhead box K2 (circFOXK2) on non-small cell lung cancer (NSCLC) persisted uncertainly. In this study, the role of circFOXK2 in NSCLC was inspected.

METHODS

The abundances of circFOXK2, microRNA-485-5p (miR-485-5p) and programmed cell death ligand-1 (PD-L1) were confirmed by quantitative real-time PCR and western blot. Cell counting kit-8 (CCK-8) assay and clonogenic assay were accomplished to conclude the proliferation of NSCLC cells. Wound healing and transwell assays were implemented to evaluate cell migration and invasion. Lactate dehydrogenase (LDH) cytotoxicity assay was enforced to quantify the cytotoxicity of CD8+ T cells. Flow cytometry assay was employed to detect apoptosis. Besides, the mice experiments were utilized for in vivo tumorigenesis analysis. Dual-luciferase reporter assay was carried out to reveal the associations between miR-485-5p and circFOXK2 or PD-L1.

RESULTS

CircFOXK2 and PD-L1 levels were augmented in NSCLC. CircFOXK2 targeted miR-485-5p, which could bind to PD-L1. CircFOXK2 served a key role in NSCLC tumorigenesis and cytotoxicity of CD8+ T cells. MiR-485-5p inhibition or PD-L1 overexpression abolished the inhibitory effects of circFOXK2 lack on NSCLC tumorigenesis and cytotoxicity of CD8+ T cells.

CONCLUSION

CircFOXK2 sponged miR-485-5p to stimulate PD-L1 and expedited NSCLC development.

Immunotherapeutic Approaches for the Treatment of HPV-Associated (Pre-)Cancer of the Cervix, Vulva and Penis

Human papillomavirus (HPV) infection drives tumorigenesis in almost all cervical cancers and a fraction of vulvar and penile cancers. Due to increasing incidence and low vaccination rates, many will still have to face HPV-related morbidity and mortality in the upcoming years. Current treatment options (i.e., surgery and/or chemoradiation) for urogenital (pre-)malignancies can have profound psychosocial and psychosexual effects on patients. Moreover, in the setting of advanced disease, responses to current therapies remain poor and nondurable, highlighting the unmet need for novel therapies that prevent recurrent disease and improve clinical outcome. Immunotherapy can be a useful addition to the current therapeutic strategies in various settings of disease, offering relatively fewer adverse effects and potential improvement in survival. This review discusses immune evasion mechanisms accompanying HPV infection and HPV-related tumorigenesis and summarizes current immunotherapeutic approaches for the treatment of HPV-related (pre-)malignant lesions of the uterine cervix, vulva, and penis.

Programme death ligand 1 expressions as a surrogate for determining immunotherapy in cervical carcinoma patients

BACKGROUND

The programme death ligand1 and its receptor (PD-1/PD-L1) interaction is a target for blockage by immunotherapy that uses the body's own immune system. Some studies show that PD-L1 expressing tumours are also more aggressive with poor prognosis. This study evaluated the immunohistochemical expression of PD-L1 in uterine cervical carcinomas. Women with cervical cancer would benefit from its use as a marker in therapy and prognosis.

METHODS

Hospital-based cross-sectional retrospective study was conducted. The study materials included 183 archived formalin fixed and paraffin embedded (FFPE) tissue blocks with histological diagnosis of cervical carcinoma diagnosed in our facility within a five-year period (January 2012 and December 2016) that met the study criteria. Data were extracted from records in the Department and immunohistochemistry was done using polyclonal antibodies to PD-L1 (GTX104763, Genetex). Obtained data were analysed using SPSS version 23. P < 0.05 was considered significant.

RESULTS

A hundred and eighty-three cases of cervical cancer were studied. PD-L1 was positive in 57.4% of all cases. The diffuse pattern of staining was the major pattern accounting for 88.5% of positive cases. Poorly differentiated cervical carcinomas are less likely to express PD-L1. Within the histologic types, the squamous cell carcinomas expressed PD-L1 in 58.7%, and 50% of adenocarcinomas were positive. PD-L1 was not expressed in all cases of adenoid cystic carcinomas and basaloid squamous cell carcinomas.

CONCLUSION

A significant population of cervical carcinoma expresses PD-L1 by immunohistochemistry. PD-L1 prevalence is lower amongst the poorly differentiated cancers compared to other grades.

Precision medicine for cervical cancer

PURPOSE OF REVIEW

To summarize the data on precision medicine for cervical cancer including the use of potential biomarkers. We also review ongoing areas of research in cervical cancer therapeutics.

RECENT FINDINGS

In the current clinical practice, programmed death ligand 1 (PD-L1) expression is used to select patients with cervical cancer for treatment with checkpoint inhibitors. However, more recently presented data suggest that PD-L1 may not be a fully accurate biomarker for selection and further analysis is warranted. With the publication of the molecular landscape of cervical cancer, tumor profile-based therapy selection is of greater interest (i.e. targeting PI3K and HER2).

SUMMARY

In this review, we discuss the role of potential biomarkers for cervical cancer that may assist with the selection of precision therapies. Enrolling patients on active clinical trials will help clarify the role of targeting specific mutations.

The miR-133b/brefeldin A-inhibited guanine nucleotide-exchange protein 1 (ARFGEF1) axis represses proliferation, invasion, and migration in cervical cancer cells

Cervical cancer is a common gynecological malignancy, and miR-133b is an abnormally expressed cervical cancer gene, which suggests that miR-133b may be involved in the occurrence and development of cervical cancer. However, the underlying mechanism is still unclear. miR-133b was overexpressed or silenced in the cervical cancer cell line C33A. Brefeldin A-inhibited guanine nucleotide-exchange protein 1 (ARFGEF1) was combined with overexpression of miR-133b in C33A cells. Cell Counting Kit-8, clone formation, and Transwell assays were performed to determine the influence of miR-133b and ARFGEF1 on clone formation, proliferation, migration, and invasion of C33A cells. The interaction between miR-133b and ARFGEF1 was verified using a luciferase reporter assay. Finally, the mRNA and protein expression of miR-133b and ARFGEF1 in the tumor and adjacent normal tissues of cervical cancer patients was detected by real-time quantitative PCR, Western blotting, and immunohistochemistry. The results indicated that miR-133b up-regulation suppressed the proliferation, invasion, migration, and clone formation abilities of C33A cells (P < 0.05). However, silence of miR-133b promoted the proliferation, invasion, and migration of C33A cells (P < 0.05). Clone formation ability of C33A cells was also elevated by miR-133b deficiency (P < 0.05). Moreover, miR-133b interacted with ARFGEF1 and repressed ARFGEF1 expression in C33A cells (P < 0.05). ARFGEF1 overexpression weakened miR-133b overexpression-mediated inhibition of proliferation, invasion, and migration of C33A cells (P < 0.05). miR-133b expression was decreased, and ARFGEF1 was up-regulated in tumor tissues of cervical cancer patients (P < 0.05). All results revealed that miR-133b suppresses cervical cancer progression by inhibiting proliferation, invasion, and migration of cervical cancer cells via targeting ARFGEF1. Thus, our study determined the mechanism of miR-133b in cervical cancer, and confirmed miR-133b/ARFGEF1 may become a potential therapeutic target for cervical cancer.

The Role of Immunotherapy in the Treatment of Advanced Cervical Cancer: Current Status and Future Perspectives

Cervical cancer remains one of the most common cancers in women around the world however therapeutic options in the advanced and recurrent setting are limited. Immune checkpoint inhibitors (ICI) have been considered an attractive option given the viral etiology of cervical cancer although the majority of patients do not benefit from their use. This review summarises current knowledge and use of immune checkpoint blockade in cervical cancer as well as discussing the challenges faced in their clinical application, namely, the role of biomarker-driven ICI use, potential mechanisms of resistance, strategies to overcome such resistance and additional immunotherapy options beyond ICI.