Immunotherapy for gynecological cancers: opportunities abound

An immunohistochemical analysis of CD3, PD-L1, and CTLA-4 expression in carcinosarcomas of the gynecological tract and their metastases

BACKGROUND

Carcinosarcoma of the gynecological tract is a rare tumor with a dismal prognosis. Its immune micro-environment has not been sufficiently studied.

AIM OF THE STUDY

To study the immune micro-environment of gynecological carcinosarcomas.

MATERIAL AND METHODS

Sixty-nine surgical specimens from 37 different patients, including 34 primary tumors and 35 metastases, were immunohistochemically studied for the expression of CD3, PD-L1, and CTLA-4. Clinical and histological features were recorded and correlated with immunohistochemical factors.

RESULTS

Twenty-two cases involved the uterine corpus, 1 the uterine cervix, and 14 the adnexa. The overall survival ranged from 2 to 156 months, with a median survival of 16 months. CD3 expression was more frequent at the sarcomatous than the carcinomatous component. CTLA-4 expression was higher at the carcinomatous than the sarcomatous component. PD-L1 was negative in all cases studied. Tumor relapse, metastasis presence, metastasis localization, and overall survival did not correlate with CD3 or CTLA-4 expression.

CONCLUSION

PD-L1 expression is not a feature of gynecological carcinosarcomas, despite a relatively frequent lymphocytic reaction. CTLA-4 expression is sometimes found in these tumors.

The immune checkpoints CTLA-4 and PD-L1 in carcinomas of the uterine cervix

BACKGROUND

Evasion of immune control is a major feature of malignant tumors. This tumor aspect is poorly studied in cervical lesions.

AIM OF THE STUDY

To investigate the expression of PD-L1 and CTLA-4 in lesions of the uterine cervix.

MATERIAL AND METHODS

Sixty-three cervical lesions from 52 patients were immunohistochemically studied. The 63 lesions included 27 invasive adenocarcinomas, 19 squamous cell carcinomas (SCCs), 7 adenocarcinomas in situ, and 10 high-grade squamous intraepithelial lesions (CIN3).

RESULTS

CTLA-4 and PD-L1 tumor cell expression was found in 61.5 % and 26.9 % of the invasive cases, respectively. CTLA-4 tumor cell expression and PD-L1 tumor and immune cell expression were more often found in SCCs than in adenocarcinomas. CTLA-4 tumor cell expression was more often found in advanced FIGO tumors. PD-L1 and CTLA-4 immune cell expression was associated with lymph node metastasis. CTLA-4 expression did not affect survival. The prognosis was worse for PD-L1-expressing tumors.

CONCLUSION

CTLA-4 and PD-L1 are potential therapeutic targets in cervical cancer.