Multifactorial, biomarker-based predictive models for immunotherapy response enter the arena
Menée à partir de données clinicopathologiques portant sur 112 patients atteints d'un cancer invasif de la vessie, cette étude évalue la possibilité de prédire, à l'aide de biomarqueurs tumoraux et cliniques (charge mutationnelle de la tumeur et score basé sur le profil génomique de la tumeur et l'expression de PD-L1, stade de la tumeur), la réponse pathologique complète (pT0N0) après un traitement par pembrolizumab
The PURE-01trial studied pre-operative treatment with theanti-PD-1 monoclonal antibody, pembrolizumab, in patients with muscle-invasive bladder cancer (MIBC) planned for cystectomy[1]. Patients were enrolled regardless of eligibility for standard cisplatin-based neoadjuvant therapy, with thegoal of developinga less toxic perioperative treatment. Cisplatin-based chemotherapy hasshown an overall survival benefit compared to surgery alone[2], so it is imperative, therefore, that any alternative neoadjuvant treatment demonstrate comparable efficacy. PURE-01, in fact, demonstrated robust clinical activity forpembrolizumab: complete pathologic response(pT0N0) was achieved in 37.5% of patients, and downstaging to less than pT2 in 58% [1, 3]. In spite of these favorable outcomes, 42 percent of patients were defined as treatment failures based on residual T2 or greater disease or radiographic progression.These patients might have beenbetter served by neoadjuvant cytotoxic chemotherapy or immediatesurgery. Accurate, practicalpredictive biomarkers are essential to distinguish between responders and non-responders tooptimizetreatment across the population.
Journal of the National Cancer Institute , éditorial en libre accès, 2019