CTLA4 blockade abrogates KEAP1/STK11-related resistance to PD-(L)1 inhibitors.
Details
Serval ID
serval:BIB_CF6BDAC4D159
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
CTLA4 blockade abrogates KEAP1/STK11-related resistance to PD-(L)1 inhibitors.
Journal
Nature
ISSN
1476-4687 (Electronic)
ISSN-L
0028-0836
Publication state
Published
Issued date
11/2024
Peer-reviewed
Oui
Volume
635
Number
8038
Pages
462-471
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
For patients with advanced non-small-cell lung cancer (NSCLC), dual immune checkpoint blockade (ICB) with CTLA4 inhibitors and PD-1 or PD-L1 inhibitors (hereafter, PD-(L)1 inhibitors) is associated with higher rates of anti-tumour activity and immune-related toxicities, when compared with treatment with PD-(L)1 inhibitors alone. However, there are currently no validated biomarkers to identify which patients will benefit from dual ICB <sup>1,2</sup> . Here we show that patients with NSCLC who have mutations in the STK11 and/or KEAP1 tumour suppressor genes derived clinical benefit from dual ICB with the PD-L1 inhibitor durvalumab and the CTLA4 inhibitor tremelimumab, but not from durvalumab alone, when added to chemotherapy in the randomized phase III POSEIDON trial <sup>3</sup> . Unbiased genetic screens identified loss of both of these tumour suppressor genes as independent drivers of resistance to PD-(L)1 inhibition, and showed that loss of Keap1 was the strongest genomic predictor of dual ICB efficacy-a finding that was confirmed in several mouse models of Kras-driven NSCLC. In both mouse models and patients, KEAP1 and STK11 alterations were associated with an adverse tumour microenvironment, which was characterized by a preponderance of suppressive myeloid cells and the depletion of CD8 <sup>+</sup> cytotoxic T cells, but relative sparing of CD4 <sup>+</sup> effector subsets. Dual ICB potently engaged CD4 <sup>+</sup> effector cells and reprogrammed the tumour myeloid cell compartment towards inducible nitric oxide synthase (iNOS)-expressing tumoricidal phenotypes that-together with CD4 <sup>+</sup> and CD8 <sup>+</sup> T cells-contributed to anti-tumour efficacy. These data support the use of chemo-immunotherapy with dual ICB to mitigate resistance to PD-(L)1 inhibition in patients with NSCLC who have STK11 and/or KEAP1 alterations.
Keywords
Kelch-Like ECH-Associated Protein 1/metabolism, Kelch-Like ECH-Associated Protein 1/genetics, Humans, Animals, Mice, Carcinoma, Non-Small-Cell Lung/drug therapy, Carcinoma, Non-Small-Cell Lung/genetics, Carcinoma, Non-Small-Cell Lung/pathology, Carcinoma, Non-Small-Cell Lung/immunology, Protein Serine-Threonine Kinases/metabolism, Protein Serine-Threonine Kinases/antagonists & inhibitors, Protein Serine-Threonine Kinases/genetics, Immune Checkpoint Inhibitors/pharmacology, Immune Checkpoint Inhibitors/therapeutic use, Drug Resistance, Neoplasm/drug effects, AMP-Activated Protein Kinase Kinases, Lung Neoplasms/drug therapy, Lung Neoplasms/genetics, Lung Neoplasms/immunology, Lung Neoplasms/pathology, CTLA-4 Antigen/antagonists & inhibitors, CTLA-4 Antigen/metabolism, B7-H1 Antigen/metabolism, B7-H1 Antigen/antagonists & inhibitors, Female, Male, Mutation, Antibodies, Monoclonal
Pubmed
Web of science
Open Access
Yes
Create date
11/10/2024 13:13
Last modification date
20/11/2024 7:16