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Construction and validation of a gene expression classifier to predict immunotherapy response in primary triple-negative breast cancer.


ABSTRACT:

Background

Immune checkpoint inhibitors (ICI) improve clinical outcomes in triple-negative breast cancer (TNBC) patients. However, a subset of patients does not respond to treatment. Biomarkers that show ICI predictive potential in other solid tumors, such as levels of PD-L1 and the tumor mutational burden, among others, show a modest predictive performance in patients with TNBC.

Methods

We built machine learning models based on pre-ICI treatment gene expression profiles to construct gene expression classifiers to identify primary TNBC ICI-responder patients. This study involved 188 ICI-naïve and 721 specimens treated with ICI plus chemotherapy, including TNBC tumors, HR+/HER2- breast tumors, and other solid non-breast tumors.

Results

The 37-gene TNBC ICI predictive (TNBC-ICI) classifier performs well in predicting pathological complete response (pCR) to ICI plus chemotherapy on an independent TNBC validation cohort (AUC = 0.86). The TNBC-ICI classifier shows better performance than other molecular signatures, including PD-1 (PDCD1) and PD-L1 (CD274) gene expression (AUC = 0.67). Integrating TNBC-ICI with molecular signatures does not improve the efficiency of the classifier (AUC = 0.75). TNBC-ICI displays a modest accuracy in predicting ICI response in two different cohorts of patients with HR + /HER2- breast cancer (AUC = 0.72 to pembrolizumab and AUC = 0.75 to durvalumab). Evaluation of six cohorts of patients with non-breast solid tumors treated with ICI plus chemotherapy shows overall poor performance (median AUC = 0.67).

Conclusion

TNBC-ICI predicts pCR to ICI plus chemotherapy in patients with primary TNBC. The study provides a guide to implementing the TNBC-ICI classifier in clinical studies. Further validations will consolidate a novel predictive panel to improve the treatment decision-making for patients with TNBC.

SUBMITTER: Ensenyat-Mendez M 

PROVIDER: S-EPMC10333210 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Construction and validation of a gene expression classifier to predict immunotherapy response in primary triple-negative breast cancer.

Ensenyat-Mendez Miquel M   Orozco Javier I J JIJ   Llinàs-Arias Pere P   Íñiguez-Muñoz Sandra S   Baker Jennifer L JL   Salomon Matthew P MP   Martí Mercè M   DiNome Maggie L ML   Cortés Javier J   Marzese Diego M DM  

Communications medicine 20230710 1


<h4>Background</h4>Immune checkpoint inhibitors (ICI) improve clinical outcomes in triple-negative breast cancer (TNBC) patients. However, a subset of patients does not respond to treatment. Biomarkers that show ICI predictive potential in other solid tumors, such as levels of PD-L1 and the tumor mutational burden, among others, show a modest predictive performance in patients with TNBC.<h4>Methods</h4>We built machine learning models based on pre-ICI treatment gene expression profiles to constr  ...[more]

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