Do tell, T-cells.

Top Line: The nobel prize wasn’t awarded for immunotherapy for nothing, but that doesn’t mean we’re not still hurting for reliable predictors of response.
The Study: Pembrolizumab won stardom as the first cancer drug approved for a tumor-agnostic indication. And that makes sense, as immune interaction with a tumor is a molecular phenomenon that isn’t necessarily dependent on any particular part of the body. Here we have a new 18-gene panel assay for inflammatory T-cells. It comes from KEYNOTE-028, a basket trial of over 20 different PD-L1-expressing tumor types. It reported an overall response rate in the teens, on par with other immunotherapy trials. Specifically it ranged from 0% for pancreatic cancer to 33% for small cell carcinoma, and higher 18-gene T-cell inflammation scores were associated with higher likelihood of response and progression-free survival. Other predictors included, you guess it, tumor mutational burden and PD-L1 expression. In fact, patients with both high T-cell inflammation and high tumor mutational burden—which aren’t necessarily associated—had the best chance of response.
Bottom Line: The 18-gene T-cell inflammation gene expression profile may help further elucidate agnostic indications for immunotherapy. | Ott, J Clin Oncol 2018


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