Clinical relevance of PD-L1 expression and CD8 T cells infiltration in patients with EGFR-mutated and ALK-rearranged lung cancer
Abstract
Objectives EGFR-mutated or ALK-rearranged non-small cell lung cancer (NSCLC) often showed unfavorable clinical benefit to checkpoint inhibitors (CPIs). However, few reports exist with integrated analysis, to interpret the underlying mechanism of poor response to PD-1/PD-L1 inhibitors. We have retrospectively analyzed the tumor microenvironment (TME) based on tumor PD-L1 expression and CD8+ T cells infiltration in patients with EGFR mutations and ALK rearrangements, and the prognostic value of TME subtypes on overall survival (OS).Materials and methods Tumor samples from 715 patients with lung cancer were retrospectively collected at Guangdong Lung Cancer Institute. Tumoral PD-L1 expression (N = 715) and CD8+ T cells infiltration (N = 658) was determined by immunohistochemistry (IHC), based on which TME was categorized into four different subtypes: PD-L1+/CD8+, PD-L1-/CD8+, PD-L1+/CD8-, PD-L1-/CD8-. Proportion of four TME subtypes was determined, and overall survival with PD-L1 expression and TME was analyzed.Results In patients with EGFR mutations or ALK rearrangements, proportion of PD-L1+/CD8+ tumors was the lowest (5.0%, 17/342), and that of PD-L1-/CD8- tumors was the highest (63.5%, 217/342). In patients with wild-type EGFR and ALK, 14.2% (45/316) tumors were PD-L1+/CD8+ and 50.3% (159/316) tumors were PD-L1-/CD8- (P < 0.001). Median OS of EGFR-mutated or ALK-rearranged lung cancer was 78.6 months in PD-L1 positive group and 93.4 months in PD-L1 negative group (HR 0.47, 95%CI 0.23-0.76, P = 0.005). PD-L1+/CD8+ group exhibited the shortest OS, with 44.3 months, but is likely to respond to CPIs. The PD-L1-/CD8+ group exhibited the longest OS but is unlikely to respond to CPIs.Conclusion Patients with EGFR mutations or ALK rearrangements exhibited lower PD-L1 and CD8 co-expression level in TME, which could be responsible for poor response to CPIs. PD-L1 and CD8 co-expression in EGFR-mutated or ALK-rearranged lung cancer is a biomarker for poor prognosis with shorter OS.
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NSCLCs harboring EGFR mutations show lower benefit with anti-PD-1/PD-L1 agents compared with EGFR wild type.
“Mounting evidence suggests that NSCLCs harboring EGFR mutations show lower benefit with the use of anti-PD-1/PD-L1 agents, compared with EGFR wild type.”
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- Authors
- Liu, S.-Y., Dong, Z.-Y., Wu, S.-P., Xie, Z., Yan, L.-X., Li, Y.-F., Yan, H.-H., Su, J., Yang, J.-J., Zhou, Q., Zhong, W.-Z., Tu, H.-Y., Yang, X.-N., Zhang, X.-C., & Wu, Y.-L.
- Affiliations
- Guangdong General Hospital (CN)
- Corresponding author
- Wu, Yi-Long
- ORCID
- Venue
- Lung Cancer
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 125
- Pages
- 86-92
- ISSN
- 0169-5002 (ISSN-L)
- OpenAlex
- W2890556710
- Cited by
- 85
- References
- 30
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 11 · 2023: 15 · 2022: 11 · 2021: 18 · 2020: 9 · 2019: 9 · 2018: 1
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Lung Cancer (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Key R&D Program of China (2016YFC1303800)
- Key Lab System Project of Guangdong Science and Technology Department
- Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer (2012A061400006, 2017B030314120)
- Public Interest by National Health and Family Control Committee (201402031)
- Guangdong Science and Technology Department (2014A020212225)
- Guangdong Provincial Applied S&T R&D Program (2016B020237006)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- PD-L1 expression, CD8+ T cell infiltration, tumor microenvironment, EGFR-mutant non-small cell lung cancer, ALK-positive non-small cell lung cancer, PD-1/PD-L1 inhibitors, immune checkpoint inhibitor response, overall survival, prognostic factors, immune evasion, EGFR wild-type
- MeSH terms
- Anaplastic Lymphoma Kinase, Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung, Female, Humans, Lung Neoplasms, Male, Middle Aged, Mutation, Prognosis, Retrospective Studies, Lymphocytes, Tumor-Infiltrating, CD8-Positive T-Lymphocytes, Disease-Free Survival, Kaplan-Meier Estimate, Young Adult, Tumor Microenvironment, B7-H1 Antigen, ErbB Receptors
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