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Ogawara D, Soda H, Tomono H, Iwasaki K, Hara T, Jinnai S, Funayama T, Okuno D, Taniguchi H, Yoshida M, Harada T, Umemura A, Fukuda Y, Yamaguchi H, Mukae H. Presence of few PD-1-expressing tumor-infiltrating immune cells is a potential predictor of improved response to salvage chemotherapy following nivolumab for non-small cell lung cancer: An exploratory case series. Thorac Cancer 2018; 9:1305-1311. [PMID: 30126069 PMCID: PMC6166078 DOI: 10.1111/1759-7714.12844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022] Open
Abstract
Background The combination of PD‐1 inhibitors and cytotoxic drugs is reported to enhance anti‐tumor activity in non‐small cell lung cancer; however, the underlying synergistic mechanisms remain uncertain. This retrospective case series was designed to investigate objective response and survival rates of salvage chemotherapy following nivolumab and explore the immunohistochemical profiles of tumor‐infiltrating immune cells. Methods The medical records of 37 patients administered nivolumab were retrospectively reviewed. Overall response rate and progression‐free survival were compared among three groups: salvage chemotherapy following nivolumab, nivolumab therapy alone, and chemotherapy preceding nivolumab. Results Eight cases met the study criteria. Salvage chemotherapy following nivolumab improved the overall response rate to 62.5% (95% confidence interval [CI] 34.4–90.6%; P = 0.004) and median progression‐free survival to six months (95% CI 4.6–7.4; P = 0.016), compared to nivolumab alone and preceding chemotherapy. The response to salvage chemotherapy was not associated with tumor PD‐L1 expression. A partial response was achieved in four cases with ≤ 5% and ≤ 2.9 cells/mm2 of PD‐1+ immune cells, whereas stable disease and progressive disease were observed in three cases with ≥ 30% and ≥ 12.7 cells/mm2. Responders had fewer PD‐1+ immune cells than non‐responders (percentage P = 0.028; density P = 0.034). Conclusion Salvage chemotherapy following nivolumab improved anti‐tumor activity regardless of tumor PD‐L1 status, but nivolumab following chemotherapy did not. The presence of few PD‐1+ tumor‐infiltrating immune cells may serve as a potential predictor of response to salvage chemotherapy. Further studies involving a large cohort are needed to clarify how nivolumab re‐sensitizes the tumor immune microenvironment to chemotherapy.
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Affiliation(s)
- Daiki Ogawara
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiroshi Soda
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiromi Tomono
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General Hospital, Nagasaki, Japan
| | - Takuya Hara
- Department of Pathology, Sasebo City General Hospital, Nagasaki, Japan
| | - Saeko Jinnai
- Department of Pathology, Sasebo City General Hospital, Nagasaki, Japan
| | - Takatomo Funayama
- Pathology Laboratory, Morphotechnology Company Limited, Sapporo, Japan
| | - Daisuke Okuno
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Hirokazu Taniguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Tatsuhiko Harada
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Asuka Umemura
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Yuichi Fukuda
- Department of Respiratory Medicine, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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