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J Immunother Cancer. 2019 Feb 11;7(1):40. doi: 10.1186/s40425-018-0492-x.

Persistent mutant oncogene specific T cells in two patients benefitting from anti-PD-1.

Author information

1
Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, MD, USA.
2
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
3
Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
4
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.
5
Division of Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, MD, USA.
6
The Swim Across America Laboratory, John Hopkins University, Baltimore, MD, USA.
7
Ludwig Center and Howard Hughes Medical Institute, Johns Hopkins University, Baltimore, MD, USA.
8
Present address: B.R.B.,Bioinformatics Core, Department of Complementary & Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, 96813, USA.
9
Immunitrack, Copenhagen, Denmark.
10
Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
11
Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, MD, USA. fhousse1@jhmi.edu.
12
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA. fhousse1@jhmi.edu.

Abstract

BACKGROUND:

Several predictive biomarkers are currently approved or are under investigation for the selection of patients for checkpoint blockade. Tumor PD-L1 expression is used for stratification of non-small cell lung (NSCLC) patients, with tumor mutational burden (TMB) also being explored with promising results, and mismatch-repair deficiency is approved for tumor site-agnostic disease. While tumors with high PD-L1 expression, high TMB, or mismatch repair deficiency respond well to checkpoint blockade, tumors with lower PD-L1 expression, lower mutational burdens, or mismatch repair proficiency respond much less frequently.

CASE PRESENTATION:

We studied two patients with unexpected responses to checkpoint blockade monotherapy: a patient with PD-L1-negative and low mutational burden NSCLC and one with mismatch repair proficient colorectal cancer (CRC), both of whom lack the biomarkers associated with response to checkpoint blockade, yet achieved durable clinical benefit. Both maintained T-cell responses in peripheral blood to oncogenic driver mutations - BRAF-N581I in the NSCLC and AKT1-E17K in the CRC - years after treatment initiation. Mutation-specific T cells were also found in the primary tumor and underwent dynamic perturbations in the periphery upon treatment.

CONCLUSIONS:

These findings suggest that T cell responses to oncogenic driver mutations may be more prevalent than previously appreciated and could be harnessed in immunotherapeutic treatment, particularly for patients who lack the traditional biomarkers associated with response. Comprehensive studies are warranted to further delineate additional predictive biomarkers and populations of patients who may benefit from checkpoint blockade.

KEYWORDS:

Checkpoint blockade; Neoantigens; Oncogene; Predictive biomarkers; T cells

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