1
|
Mesnage SJL, Auguste A, Genestie C, Dunant A, Pain E, Drusch F, Gouy S, Morice P, Bentivegna E, Lhomme C, Pautier P, Michels J, Le Formal A, Cheaib B, Adam J, Leary AF. Neoadjuvant chemotherapy (NACT) increases immune infiltration and programmed death-ligand 1 (PD-L1) expression in epithelial ovarian cancer (EOC). Ann Oncol 2017; 28:651-657. [PMID: 27864219 DOI: 10.1093/annonc/mdw625] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lymphocytic infiltration at diagnosis is prognostic in EOC, however, the impact of NACT on tumour infiltrating lymphocytes (TILs) or PD-L1 expression remains poorly described. Patients and methods Patients with EOC and sequential samples (pre-NACT, post-NACT or relapse) were retrospectively identified. TILs were evaluated on whole sections; stromal TILs (sTILs) scored as percentage of stromal area with high sTILs defined as ≥50%; intra-epithelial TILs (ieTILs) scored semi-quantitatively (0-3) with high ieTILs ≥2. A smaller number were available for PD-L1 evaluation, cut-off for positivity was ≥5% staining. Results sTILs were detected in all tumours at diagnosis (range 2-90%, median 20%), with 22% (25/113) showing high sTILs. Among evaluable paired pre/post-NACT samples (N = 83), an overall increase in median sTILs from 20% to 30% was seen following NACT (P = 0.0005); individually the impact of NACT varied with sTILs increasing in 51% (42/83), decreasing in 25%, and stable in 24%. Post-NACT sTILs were predictive of platinum-free interval (PFI), patients with PFI ≥6 months had significantly higher post-NACT sTILs (sTILs 28% versus 18% for PFI <6 months, P = 0.026); pre-NACT sTILS were not predictive. At diagnosis, 23% showed high ieTILs, and following NACT 33% showed increasing ieTILs. Proportion of tumours with PD-L1-positive immune cells was 30% (15/50) pre-NACT and 53% (27/51) post-NACT (P = 0.026). Among paired tumours, 63% of PD-L1-negative tumours became positive after NACT, furthermore cisplatin induced PD-L1 expression in PD-L1-negative EOC cell lines. On multivariate analysis, high sTILs both pre- and post-NACT were independent prognostic factors for progression-free survival (PFS) (HR 0.49, P = 0.02 and HR 0.60, P = 0.05, respectively). No prognostic impact of ieTILs or PD-L1 expression was detected. Conclusions In EOC, sTILs levels are prognostic at diagnosis and remain prognostic after NACT. TILs and PD-L1 expression increase following NACT. Evaluation of immune parameters in the post-NACT tumour may help select patients for immunotherapy trials.
Collapse
Affiliation(s)
- S J L Mesnage
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif
| | - A Auguste
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay
| | - C Genestie
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Departments of Biopathology, Gustave Roussy, Villejuif, France
| | - A Dunant
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - E Pain
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif
| | - F Drusch
- Translational Research and Histocytopathology Laboratory, Gustave Roussy, 114 rue E Vaillant, 94805, Villejuif, France
| | - S Gouy
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - P Morice
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - E Bentivegna
- Gustave Roussy, Université Paris-Saclay, Department of Gynecologic Surgery, F-94805, Villejuif, France
| | - C Lhomme
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - P Pautier
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - J Michels
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - A Le Formal
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay
| | - B Cheaib
- Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - J Adam
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Departments of Biopathology, Gustave Roussy, Villejuif, France
| | - A F Leary
- INSERM U981 Gynaecological Tumours, Gustave Roussy Cancer Center, Villejuif.,Faculty of Sciences, University Paris-Sud, Orsay.,Oncology, Gustave Roussy Cancer Center, Villejuif, France
| |
Collapse
|
2
|
Mesnage SJL, Auguste A, Genestie C, Dunant A, Pain E, Drusch F, Gouy S, Morice P, Bentivegna E, Lhomme C, Pautier P, Michels J, Le Formal A, Cheaib B, Adam J, Leary A. Pattern of tumor-infiltrating lymphocytes (TILs) and PD-L1 expression in primary and metastatic epithelial ovarian cancer (EOC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
64 Background: Tumour immune response plays a critical role in progression and prognosis of EOC, however patterns of TILs and PD-L1 expression in primary and metastatic disease remain poorly described. Methods: Patients treated with neoadjuvant chemotherapy (NACT) for advanced EOC, between 2002-2014, and available sequential tumours (pre-NACT, post-NACT, or relapse) were retrospectively identified. Stromal TILs (sTILs) were evaluated according to the International TILs Working Group 2014 (Salgado 2015) on whole sections, and scored as a percentage of stromal area. Immune cell PD-L1 expression was evaluated by immunohistochemistry (E1L3N clone, Cell Signaling) in a smaller number of tumours. Cutoffs for analysis were: high sTILs ≥50%, PD-L1 positivity ≥5% membranous staining. Results: Among a total of 236 tumour samples from 150 patients (110 pre-NACT, 111 post-NACT, and 15 relapse tumours) median sTILs levels was significantly higher in metastatic tumours ( n=151) compared with primary tumours ( n=85) (median 30, IQR 10-50 vs. 15, IQR 5-30, p=0.0004). Among diagnostic samples, median sTILs level was 20 (IQR 10-45, n=85) in metastatic tumours compared with 10 (IQR 5-20, n =25) in primary tumours ( p=0064). Similarly in post-NACT samples, median sTILs level was 40 (IQR 15-60, n=51) in metastatic tumours compared with 20 (IQR 6.25-30, n=60) in primary tumours ( p=0026). Among relapse samples median sTILs level was 30 (IQR 10-50, n=15). Among all available samples ( n=97) PD-L1 positivity was detected in 33% (9/30) of primary and 50% (34/68) of metastatic tumours (Fisher’s exact test OR 2.3, 95%CI 0.94-5.4, p =0.08). Conclusions: In patients with EOC there is increased lymphocytic infiltration in both synchronous metastatic disease at diagnosis, and metachronous metastatic disease at relapse, compared with the primary tumour. This suggests increased immunogenicity as disease progresses. Furthermore, there is a trend towards upregulation of the PD-L1 immune checkpoint with disease progression.
Collapse
Affiliation(s)
| | - Aurelie Auguste
- INSERM U981, Gustave Roussy Cancer Center, Villejuif, France
| | | | | | - Erwann Pain
- Gustave Roussy Cancer Center, Villejuif, France
| | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Cancer Centre, Villejuif, France
| | - Enrica Bentivegna
- Department of Surgery, Gustave Roussy Cancer Center, Villejuif, France
| | - Catherine Lhomme
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | | | - Judith Michels
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | | | | | - Julien Adam
- Department of Biopathology, Gustave Roussy Cancer Center, Villejuif, France
| | | |
Collapse
|
3
|
Rivalland G, Lawrence BJ, Mesnage SJL, Reeve J, Findlay MPN. Cisplatin, epirubicin, capecitabine, and gemcitabine (PEXG) as first-line treatment in metastatic or unresectable pancreatic cancer: Active and well tolerated? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Jane Reeve
- Auckland City Hospital, Auckland, New Zealand
| | - Michael P. N. Findlay
- Cancer Trials New Zealand, Discipline of Oncology, The University of Auckland, Auckland, New Zealand
| |
Collapse
|