Impact of Molecular Subtyping and Immune Infiltration on Pathological Response and Outcome Following Neoadjuvant Pembrolizumab in Muscle-invasive Bladder Cancer.

The PURE-01 study (NCT02736266) evaluated the use of pembrolizumab before radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC).

To evaluate the ability of molecular signatures to predict the pathological complete response (CR: ypT0N0) and progression-free survival (PFS) after pembrolizumab and RC.

We analyzed the expression data from patients with T2-4aN0M0 MIBC enrolled in the PURE-01 study (N=84) and from patients of a retrospective multicenter cohort treated with cisplatin-based neoadjuvant chemotherapy (NAC; N=140).

Neoadjuvant pembrolizumab or NAC and RC.

Immune signatures and molecular subtyping (The Cancer Genome Atlas, consensus model, and genomic subtyping classifier [GSC]) were evaluated in relation to CR and PFS. Multivariable logistic regression analyses for CR were used, adjusting for gender and clinical T stage.

The Immune190 signature was significant for CR on multivariable logistic regression analyses (p= 0.02) in PURE-01, but not in the NAC cohort (p= 0.7). Hallmark signatures for interferon gamma (IFNγ; p= 0.004) and IFNα response (p= 0.006) were also associated with CR for PURE-01, but not for NAC (IFNγ: p= 0.9 and IFNα: p= 0.8). In PURE-01, 93% of patients with the highest Immune190 scores (>1st quartile) had 2-yr PFS versus 79% of those with lower scores; no difference was observed in NAC patients, as well as for the other hallmarks in both groups. The neuroendocrine-like subtype had the worst 2-yr PFS in all three subtyping models (33%) and the GSC claudin-low subtype had the best, with no recurrences in 2 yr. Basal subtypes (across classifications) with higher Immune190 scores showed 100% 2-yr PFS after pembrolizumab therapy (p = 0.04, compared with basal-Immune190 low). Statistical analyses are limited by the small number of events and short follow-up.

Higher RNA-based immune signature scores were significantly associated with CR and numerically improved PFS outcomes after pembrolizumab, but not after NAC. These data emphasize that RNA profiling is a potential tool for personalizing neoadjuvant therapy selection.

We used gene expression profiling to evaluate the association between immune gene expression and response to neoadjuvant immunotherapy, compared with standard chemotherapy, in patients with muscle-invasive bladder cancer (MIBC). We found a significant association between immune gene expression and response to pembrolizumab, but not chemotherapy. We conclude that gene expression profiling has the potential to guide personalized neoadjuvant therapy in MIBC.

European urology. 2020 Mar 09 [Epub ahead of print]

Andrea Necchi, Daniele Raggi, Andrea Gallina, Jeffrey S Ross, Elena Farè, Patrizia Giannatempo, Laura Marandino, Maurizio Colecchia, Roberta Lucianò, Marco Bianchi, Renzo Colombo, Andrea Salonia, Giorgio Gandaglia, Nicola Fossati, Marco Bandini, Filippo Pederzoli, Umberto Capitanio, Francesco Montorsi, Joep J de Jong, Ryan Dittamore, Yang Liu, Elai Davicioni, Joost L Boormans, Alberto Briganti, Peter C Black, Ewan A Gibb

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: ., Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Foundation Medicine, Cambridge, MA, USA; Upstate Medical University, New York, NY, USA., Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Decipher Biosciences Inc., Vancouver, British Columbia, Canada., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Decipher Biosciences Inc., Vancouver, British Columbia, Canada. Electronic address: .

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