1. Clonal KEAP1 mutations with loss of heterozygosity share reduced immunotherapy efficacy and low immune cell infiltration in lung adenocarcinoma.
- Author
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Scalera, S., Ricciuti, B., Mazzotta, M., Calonaci, N., Alessi, J.V., Cipriani, L., Bon, G., Messina, B., Lamberti, G., Di Federico, A., Pecci, F., Milite, S., Krasniqi, E., Barba, M., Vici, P., Vecchione, A., De Nicola, F., Ciuffreda, L., Goeman, F., and Fanciulli, M.
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IMMUNE checkpoint inhibitors , *HETEROZYGOSITY , *SOMATIC mutation , *GENETIC mutation , *IMMUNOTHERAPY - Abstract
KEAP1 mutations have been associated with reduced survival in lung adenocarcinoma (LUAD) patients treated with immune checkpoint inhibitors (ICIs), particularly in the presence of STK11 / KRAS alterations. We hypothesized that, beyond co-occurring genomic events, clonality prediction may help identify deleterious KEAP1 mutations and their counterparts with retained sensitivity to ICIs. Beta-binomial modelling of sequencing read counts was used to infer KEAP1 clonal inactivation by combined somatic mutation and loss of heterozygosity (KEAP1 C-LOH) versus partial inactivation [ KEAP1 clonal diploid-subclonal (KEAP1 CD-SC)] in the Memorial Sloan Kettering Cancer Center (MSK) MetTropism cohort (N = 2550). Clonality/LOH prediction was compared to a streamlined clinical classifier that relies on variant allele frequencies (VAFs) and tumor purity (TP) (VAF/TP ratio). The impact of this classification on survival outcomes was tested in two independent cohorts of LUAD patients treated with immunotherapy (MSK/Rome N = 237; DFCI N = 461). Immune-related features were studied by exploiting RNA-sequencing data (TCGA) and multiplexed immunofluorescence (DFCI mIF cohort). Clonality/LOH inference in the MSK MetTropism cohort overlapped with a clinical classification model defined by the VAF/TP ratio. In the ICI-treated MSK/Rome discovery cohort, predicted KEAP1 C-LOH mutations were associated with shorter progression-free survival (PFS) and overall survival (OS) compared to KEAP1 wild-type cases (PFS log-rank P = 0.001; OS log-rank P < 0.001). Similar results were obtained in the DFCI validation cohort (PFS log-rank P = 0.006; OS log-rank P = 0.014). In both cohorts, we did not observe any significant difference in survival outcomes when comparing KEAP1 CD-SC and wild-type tumors. Immune deconvolution and multiplexed immunofluorescence revealed that KEAP1 C-LOH and KEAP1 CD-SC differed for immune-related features. KEAP1 C-LOH mutations are associated with an immune-excluded phenotype and worse clinical outcomes among advanced LUAD patients treated with ICIs. By contrast, survival outcomes of patients whose tumors harbored KEAP1 CD-SC mutations were similar to those with KEAP1 wild-type LUADs. • Variant allele frequency and tumor purity frame deleterious KEAP1 mutations in LUAD. • Clonal KEAP1 mutations with LOH (KEAP1 C-LOH) define a subset of LUAD patients unresponsive to immunotherapy. • Preserved immunotherapy efficacy was noticed in tumors with clonal diploid/subclonal KEAP1 mutations (KEAP1 CD-SC). • Immune-related pathways and markers were differentially represented across KEAP1 C-LOH, KEAP1 CD-SC, and wild-type tumors. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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