Peripheral Cytokine Levels as Predictive Biomarkers of Benefit from Immune Checkpoint Inhibitors in Cancer Therapy

Abstract

Background : Currently, only a small subset of cancer patients can benefit from anti-PD-1/PD-L1 monotherapy, indicating that further predictive biomarkers are needed.

Methods: In the retrospective study, plasma samples were collected before anti-PD-L1/PD-L1 treatment in two subset of patients. A total of 59 immunological factors, including cytokines, chemokines, and soluble immune checkpoints, were measured by using a multiplex immunoassay kit. Moreover, multiplex immunohistochemistry (mIHC) was performed in a subgroup of patients.

Findings: In the discovery cohort, multiplex immunoassay profiling data revealed that both soluble PD-L1 and C-C motif chemokine 5 (CCL5/RANTES) showed rising trends across the three subgroups PD, SD and CR/PR. Further investigation demonstrated the predictive and prognostic value of the pre-treatment levels of PD-L1, CCL5/RANTES, and their combinatorial signature the “2-cytokine signature”. As expected, the signature-high patients displayed a remarkably increased disease control rate (DCR) and prolonged survival versus that of the lower subgroup. More importantly, the relevance between the three signatures and the efficiency of immunotherapy was confirmed in the pan-cancer validation cohort. Notably, the significant association between the “2-cytokine signature” and longer survival was validated. Further quantitative analyses of the tumor microenvironment composition suggested a link between the “2-cytokine signature” and NK cell infiltration.

Interpretation: A combined peripheral signature comprising CCL5/RANTES and soluble PD-L1 appears to be an effective biomarker to predict benefit from anti-PD-1/PD-L1 monotherapy. Our study underscores that peripheral immunological features may play an essential role in guiding patient selection and are worthy of future prospective investigations.

Funding: This work was supported by The National Key Sci-Tech Special Project of China (No. 2018ZX10302207).

Declaration of Interests: HZ has received research funding from The National Key Sci-Tech Special Project of China. The remaining authors declare no competing financial interests.

Ethics Approval Statement: This study was approved by the Internal Review and the Ethics Boards of the Fifth Medical Center, General Hospital of the PLA and were performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from each patient.