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Élez E, Mulet-Margalef N, Sanso M, Ruiz-Pace F, Mancuso FM, Comas R, Ros J, Argilés G, Martini G, Sanz-Garcia E, Baraibar I, Salvà F, Noguerido A, Cuadra-Urteaga JL, Fasani R, Garcia A, Jimenez J, Aguilar S, Landolfi S, Hernández-Losa J, Braña I, Nuciforo P, Dienstmann R, Tabernero J, Salazar R, Vivancos A. A Comprehensive Biomarker Analysis of Microsatellite Unstable/Mismatch Repair Deficient Colorectal Cancer Cohort Treated with Immunotherapy. Int J Mol Sci 2022; 24:ijms24010118. [PMID: 36613564 PMCID: PMC9820517 DOI: 10.3390/ijms24010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The search for immunotherapy biomarkers in Microsatellite Instability High/Deficient Mismatch Repair system (MSI-H/dMMR) metastatic colorectal cancer (mCRC) is an unmet need. Sixteen patients with mCRC and MSI-H/dMMR (determined by either immunohistochemistry or polymerase chain reaction) treated with PD-1/PD-L1 inhibitors at our institution were included. According to whether the progression-free survival with PD-1/PD-L1 inhibitors was longer than 6 months or shorter, patients were clustered into the IT-responder group (n: 9 patients) or IT-resistant group (n: 7 patients), respectively. In order to evaluate determinants of benefit with PD-1/PD-L1 inhibitors, we performed multimodal analysis including genomics (through NGS panel tumour-only with 431 genes) and the immune microenvironment (using CD3, CD8, FOXP3 and PD-L1 antibodies). The following mutations were more frequent in IT-resistant compared with IT-responder groups: B2M (4/7 versus 2/9), CTNNB1 (2/7 versus 0/9), and biallelic PTEN (3/7 versus 1/9). Biallelic ARID1A mutations were found exclusively in the IT-responder group (4/9 patients). Tumour mutational burden did not correlate with immunotherapy benefit, neither the rate of indels in homopolymeric regions. Of note, biallelic ARID1A mutated tumours had the highest immune infiltration and PD-L1 scores, contrary to tumours with CTNNB1 mutation. Immune microenvironment analysis showed higher densities of different T cell subpopulations and PD-L1 expression in IT-responders. Misdiagnosis of MSI-H/dMMR inferred by discordances between immunohistochemistry and polymerase chain reaction was only found in the IT-resistant population (3/7 patients). Biallelic ARID1A mutations and Wnt signalling activation through CTNNB1 mutation were associated with high and low T cell immune infiltrates, respectively, and deserve special attention as determinants of response to PD-1/PD-L1 inhibitors. The non-MSI-H phenotype in dMMR is associated with poor benefit to immunotherapy. Our results suggest that mechanisms of resistance to immunotherapy are multi-factorial.
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Affiliation(s)
- Elena Élez
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Núria Mulet-Margalef
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Colorectal Cancer Unit, Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Miriam Sanso
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Genomics for Precision Oncology Laboratory, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Fiorella Ruiz-Pace
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Francesco M. Mancuso
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Research and Development Department, Universal Diagnostics S.L., 41013 Sevilla, Spain
| | - Raquel Comas
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Javier Ros
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Departament of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy
| | - Guillem Argilés
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Giulia Martini
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Departament of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy
| | - Enrique Sanz-Garcia
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Iosune Baraibar
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Francesc Salvà
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Alba Noguerido
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Jose Luis Cuadra-Urteaga
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Medical Oncology, IOB—Hospital Quirón, 08023 Barcelona, Spain
| | - Roberta Fasani
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Ariadna Garcia
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Jose Jimenez
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Susana Aguilar
- Molecular Prescreening Program, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Stefania Landolfi
- Department of Pathology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | | | - Irene Braña
- Medical Oncology Department, Research Unit for Molecular Therapy of Cancer, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Josep Tabernero
- Colorectal Cancer Program, Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Ramon Salazar
- Colorectal Cancer Unit, Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, Oncobell Program (IDIBELL), CIBERONC, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-543-450
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Cedres S, Hernando-Calvo A, Iranzo P, Callejo A, Aranda NP, Navarro A, Martinez-Marti A, Assaf J, Miquel J, Rodriguez G, Monton V, Pedrola A, Viaplana C, Carbonell C, Sanso M, Dienstmann R, Amat R, Vivancos A, Felip E. P1.16-05 Incidence and Outcome of Multiple Primary Cancers (MPC) in a Series of Lung Cancer (LC) Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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