Li et al. performed a multiyear study, prospectively analyzing peripheral immune cells and plasma cytokines from 124 patients with advanced pan-solid tumors treated with anti-PD-L1 or anti-PD-1. 30 patients achieved CR or durable PR with PFS ≥1 year, and exhibited higher levels of Th17-associated cytokines (IL-17F, -21, -23) and lower IL-8 levels at baseline and early on treatment than lesser responders. The latter showed elevated on-treatment IL-6, decreased Th17 cells, expansion of exhausted-like Th17 cells with lower lymphoid trafficking markers during early treatment, and trended toward higher on-treatment neutrophil-to-lymphocyte ratios.

Contributed by Paula Hochman

ABSTRACT: Immune checkpoint inhibitors (ICIs) have transformed cancer care, at times generating durable partial or even complete responses in advanced cancers. However, only a minority of patients experience these "excellent" responses. Thus, there is a need for novel biomarkers that can identify those with robust clinical benefit. To address this, we prospectively collected blood samples from 124 patients with advanced and/or metastatic pan-solid tumors treated as standard of care with anti-PD1 or anti-PDL1 alone or in combination with other agents. In this cohort, 30 of 124 (24.2%) patients were classified as excellent responders (ERs), defined as experiencing a complete response or a durable partial response with progression-free survival (PFS) ³ one year. Peripheral immune cells were analyzed by Cytometry by Time-of-Flight and cytokines were analyzed using a multiplex immunoassay. At baseline and early-on-treatment, ERs had elevated concentrations of Th17-associated cytokines, IL-17F, IL-21, and IL-23, and decreased IL-8 compared to non-ERs (p<0.05). Elevated on-treatment IL-6 was also associated with non-ERs (p<0.05). High baseline IL-17F and IL-23 were associated with superior PFS, and high baseline IL-8 with inferior overall survival (p<0.05). Non-ERs demonstrated decreased proportions of Th17 cells from baseline to early-on-treatment. Regression analysis of functional markers in non-ERs showed a proliferation of exhaustion-like Th17 cells (Ki67+TIGIT+) from baseline to early-on-treatment (p<0.01), which was not present in ERs. This study identifies the Th17 pathway as a potential correlate of excellent ICI response and represents a comprehensive exploration of peripheral immune signatures associated with durable ICI benefit.

Author Info: (1) Sidney Kimmel Comprehensive Cancer Center Baltimore, MD United States. (2) Johns Hopkins Medicine Baltimore, MD United States. (3) Johns Hopkins Medicine Baltimore, MD United S tates. (4) Sidney Kimmel Comprehensive Cancer Center United States. (5) Johns Hopkins Medicine Baltimore, MD United States. (6) Sidney Kimmel Comprehensive Cancer Center Baltimore, MD United States. (7) Sidney Kimmel Comprehensive Cancer Center United States. (8) Johns Hopkins University United States. (9) Johns Hopkins Medicine Baltimore, MD United States. (10) Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Baltimore, MD United States. (11) Johns Hopkins Medicine Baltimore, Maryland United States. (12) Sidney Kimmel Comprehensive Cancer Center United States. (13) Johns Hopkins Medicine Baltimore, MD United States. (14) Johns Hopkins Medicine Baltimore United States. (15) Johns Hopkins Medicine Baltimore, MD United States. (16) Johns Hopkins Medicine BALTIMORE, MD United States. (17) Johns Hopkins Medicine Baltimore, MD United States. (18) Roche (Switzerland) Basel Switzerland. (19) Roche (Switzerland) Basel Switzerland. (20) Genentech South San Francisco, CA United States. (21) Genentech San Francisco, CA United States. (22) Genentech San Francisco, CA United States. (23) Johns Hopkins University Baltimore, MD United States. (24) Johns Hopkins Medicine Baltimore, MD United States. (25) Johns Hopkins University Baltimore, MD United States. (26) Johns Hopkins Medicine Baltimore, MD United States. (27) Johns Hopkins Medicine Baltimore, MD United States.