Journal Article

Spatial interactions of immune cells as potential predictors to efficacy of toripalimab plus chemotherapy in locally advanced or metastatic pancreatic ductal adenocarcinoma: a phase Ib/II trial

He, Du, Zhao, Chengjian, Cheng, Ke, Zhang, Yi, Li, Zhiping, Zhou, Ruihan, You, Xin, Yang, Heqi, Zhao, Gang, Li, Ruizhen, Yi, Cheng, Xiao, Chaoxin, Xiong, Junjie, Chang, Chen, Huang, Zixin, Wang, Rui, Li, Xiaoying, Shao, Weikang, Lv, Wanrui, Guo, Wenhao, Yan, Ouying, Ling, Wenwu, Chen, Ye, Cao, Dan, Tian, Bole

2024

Overview

Advanced pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis. Immunotherapy alone offers limited efficacy, but it is still unknown whether its combination with chemotherapy could offer synergistic anti-tumor effects. This phase Ib/II study evaluated the safety and efficacy of combining toripalimab with the gemcitabine plus nab-paclitaxel (GnP) regimen as first-line treatment for locally advanced or metastatic PDAC and explored predictive biomarkers (ChiCTR2000032293). The primary endpoints were safety and overall survival (OS). The secondary outcomes were objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS). Immune-related biomarkers including programmed death-ligand 1 (PD-L1) expression, genetic status, cytokine levels, and spatial features of the tumor immune microenviroment (TIME) were investigated. Neither serious treatment-related adverse events nor grade 4 immune-related adverse events were reported. Among the 72 patients, the median OS was 8.9 months, 12-month OS rate was 31.9%, with median PFS of 5.6 months, ORR of 33.3%, and DCR of 90.3%. Higher PD-L1 expression, without liver metastases were associated with higher ORR, however these factors could not effectively distinguish responders and non-responders. Importantly, dendritic cells - T helper cells - cytotoxic T lymphocytes (DC-Th-CTL) enriched immune niche and their spatial interactions were dominant predictors of response based on TIME analysis using a cyclic multiplex tissue staining assay, with an area under the curve value of 0.8. Overall, GnP plus toripalimab exhibited good safety and differentiated efficacy in selected population, and the spatial interactions of DC-Th-CTL represent promising predictors to efficacy of immunochemotherapy in locally advanced or metastatic PDAC.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/4028/67/327 / 692/53/2423 / Adenocarcinoma / Adenocarcinoma - drug therapy / Adenocarcinoma - immunology / Adenocarcinoma - pathology / Adult / Adverse events / Aged / Albumins - administration & dosage / Antibodies, Monoclonal, Humanized - administration & dosage / Antibodies, Monoclonal, Humanized - therapeutic use / Antineoplastic Combined Chemotherapy Protocols - administration & dosage / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Apoptosis / Biomarkers / Biomarkers, Tumor - genetics / Cancer Research / Carcinoma, Pancreatic Ductal - drug therapy / Carcinoma, Pancreatic Ductal - immunology / Carcinoma, Pancreatic Ductal - pathology / Cell Biology / Cell Communication / Cell survival / Chemotherapy / Cytotoxicity / Dendritic cells / Deoxycytidine - administration & dosage / Deoxycytidine - analogs & derivatives / Disease control / Female / Gemcitabine / Helper cells / Humans / Immunotherapy / Internal Medicine / Lymphocytes T / Male / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Metastasis / Middle Aged / Neoplasm Metastasis / Neoplasm Staging / Oncology / Paclitaxel / Paclitaxel - administration & dosage / Pancreas / Pancreatic cancer / Pancreatic Neoplasms - drug therapy / Pancreatic Neoplasms - immunology / Pancreatic Neoplasms - pathology / Pathology / PD-L1 protein / Treatment Outcome / Tumor Microenvironment - drug effects / Tumor Microenvironment - immunology / Tumors