Chemoradiation therapy alters the PD-L1 score in locoregional recurrent squamous cell carcinomas of the head and neck

• Type of Material: Article
• Authors: Brian J. Park, Harvard University; Austin K. Mattox, Johns Hopkins University; Daniel Clayburgh, Oregon Health and Science University; Mihir Patel, Emory University; R. Bryan Bell, Providence Cancer Institute; Bevan Yueh, University of Minnesota; Rom Leidner, Providence Cancer Institute; Hong Xiao, Providence Health and Services, Oregon; Marcus Couey, Providence Health and Services, Oregon; Shiting Li, University of Michigan, Ann Arbor; Tingting Qin, University of Michigan, Ann Arbor; Maureen A. Sartor, University of Michigan, Ann Arbor; Belinda Cairns, AbbVie Biotherapeutics; Tracy MacDonough, AbbVie Biotherapeutics; Kyle Halliwill, AbbVie Biotherapeutics; Daniel Deschler, Harvard University; Derrick T. Lin, Harvard University; William C. Faquin, Harvard University; Peter M. Sadow, Harvard University; Sara I. Pai, Harvard University
• Language: English
• Date: 2022-10-07
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.oraloncology.2022.106183
• Title of Journal or Parent Work: Oral Oncology
• Volume: 135
• Start Page: 106183
• Grant/Funding Information: This work was supported by the National Institutes of Health/National Cancer Institute (NIH/NCI P01 240239 (DTL, WCF, PMS, SIP), R01 CA 257623 (WCF, SIP), and Abbvie.
• Keywords: PD-L1 testing; head and neck squamous cell carcinoma; chemoradiation therapy; PD-L1 combined positive score
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Immunology; Health Sciences, Oncology

Abstract

PD-L1 testing guides therapeutic decision-making for head and neck squamous cell carcinoma (HNSCC). We sought to understand whether chemoradiation therapy (CRT) influences the PD-L1 combined positive score (CPS) and other biomarkers of response to immunotherapy. PD-L1 expression was assessed using immunohistochemistry, and bulk RNA sequencing was performed on 146 HNSCC patients (65 primary sites, 50 paired local recurrences, and 31 paired regional recurrences). PD-L1 was scored using the CPS of ≥1, ≥20, and ≥50. Overall, 98 %, 54 %, and 17 % of HNSCCs had a CPS ≥1, ≥20, and ≥50, respectively. When using a cut-off of ≥1, CRT did not significantly change CPS at the locoregional recurrent site. However, there were significant changes when using CPS ≥20 or ≥50. The CPS changed for 32 % of patients when using a CPS ≥20 (p < 0.001). When using a CPS ≥50, there was a 20–23 % (p = 0.0058–0.00067) discordance rate at the site of locoregional recurrence. Oral cavity cancers had a significantly higher discordant rate than other primary sites for CPS ≥50, 44 % (8/18, p = 0.0058) and 58 % (7/12, p = 0.00067) discordance at the site of local and regional recurrence, respectively. When evaluating the 18 gene IFN-ɣ signature predictive of response to anti-PD-1 blockade, there was a statistically significant increase in the IFN-ɣ signature in recurrent larynx cancer (p = 0.02). Our study demonstrates that when using a higher cut-off of CPS ≥20 and ≥50, a repeat biopsy may be warranted after CRT for local and regional recurrent HNSCCs.