Trans-arterial chemoembolization as a loco-regional inducer of immunogenic cell death in hepatocellular carcinoma: implications for immunotherapy

BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.M...

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Vydané v:Journal for immunotherapy of cancer Ročník 9; číslo 9; s. e003311
Hlavní autori: Pinato, David J., Murray, Sam M, Forner, Alejandro, Kaneko, Takahiro, Fessas, Petros, Toniutto, Pierluigi, Mínguez, Beatriz, Cacciato, Valentina, Avellini, Claudio, Diaz, Alba, Boyton, Rosemary J., Altmann, Daniel M., Goldin, Robert D, Akarca, Ayse U, Marafioti, Teresa, Mauri, Francesco A, Casagrande, Edoardo, Grillo, Federica, Giannini, Edoardo, Bhoori, Sherrie, Mazzaferro, Vincenzo
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England BMJ Publishing Group Ltd 01.09.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Edícia:Original research
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ISSN:2051-1426, 2051-1426
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Abstract BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.MethodsWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T− (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.ResultsWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T−. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T−.ConclusionsTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.
AbstractList BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.MethodsWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T− (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.ResultsWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T−. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T−.ConclusionsTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.
Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment. We profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163. We analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-. TACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.
Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.BACKGROUNDModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.We profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.METHODSWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.We analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-.RESULTSWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-.TACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.CONCLUSIONSTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.
Author Forner, Alejandro
Giannini, Edoardo
Marafioti, Teresa
Mazzaferro, Vincenzo
Goldin, Robert D
Diaz, Alba
Fessas, Petros
Altmann, Daniel M.
Boyton, Rosemary J.
Avellini, Claudio
Toniutto, Pierluigi
Pinato, David J.
Mínguez, Beatriz
Murray, Sam M
Kaneko, Takahiro
Akarca, Ayse U
Mauri, Francesco A
Bhoori, Sherrie
Grillo, Federica
Cacciato, Valentina
Casagrande, Edoardo
AuthorAffiliation 14 Department of Surgery and Cancer , Imperial College London , London , UK
3 Department of Infectious Diseases, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK
11 Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic , University of Barcelona , Barcelona , Spain
8 Liver Unit, Hospital Universitari Vall d’Hebron , Universitat Autonoma de Barcelona , Barcelona , Spain
16 Department of Oncology , University of Milan , Milano , Italy
10 Institute of Histopathology , Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" , Udine , Italy
13 Department of Histopathology , University College London Cancer Institute , London , UK
15 Department of Surgical Sciences , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy
1 Department of Surgery & Cancer, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK
7 Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME) , Un
AuthorAffiliation_xml – name: 7 Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME) , University of Udine , Udine , Italy
– name: 15 Department of Surgical Sciences , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy
– name: 2 Division of Oncology, Department of Translational Medicine , Universita del Piemonte Orientale "A. Avogadro" , Novara , Italy
– name: 9 Gastroenterology Unit, Department of Internal Medicine , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy
– name: 10 Institute of Histopathology , Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" , Udine , Italy
– name: 11 Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic , University of Barcelona , Barcelona , Spain
– name: 14 Department of Surgery and Cancer , Imperial College London , London , UK
– name: 3 Department of Infectious Diseases, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK
– name: 12 Centre for Pathology , Imperial College London , London , UK
– name: 4 Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group , University of Barcelona, Hospital Clinic , Barcelona , Spain
– name: 16 Department of Oncology , University of Milan , Milano , Italy
– name: 8 Liver Unit, Hospital Universitari Vall d’Hebron , Universitat Autonoma de Barcelona , Barcelona , Spain
– name: 13 Department of Histopathology , University College London Cancer Institute , London , UK
– name: 1 Department of Surgery & Cancer, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK
– name: 5 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Instituto de Salud Carlos III , Madrid , Spain
– name: 6 Tokyo Medical and Dental University , Bunkyo-ku , Japan
– name: 17 Hepato-Pancreatic-Biliary Surgery and Liver Transplantation , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
Author_xml – sequence: 1
  givenname: David J.
  orcidid: 0000-0002-3529-0103
  surname: Pinato
  fullname: Pinato, David J.
  email: david.pinato@imperial.ac.uk
  organization: Division of Oncology, Department of Translational Medicine, Universita del Piemonte Orientale "A. Avogadro", Novara, Italy
– sequence: 2
  givenname: Sam M
  surname: Murray
  fullname: Murray, Sam M
  organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
– sequence: 3
  givenname: Alejandro
  surname: Forner
  fullname: Forner, Alejandro
  organization: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
– sequence: 4
  givenname: Takahiro
  surname: Kaneko
  fullname: Kaneko, Takahiro
  organization: Tokyo Medical and Dental University, Bunkyo-ku, Japan
– sequence: 5
  givenname: Petros
  orcidid: 0000-0002-7472-8913
  surname: Fessas
  fullname: Fessas, Petros
  organization: Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
– sequence: 6
  givenname: Pierluigi
  surname: Toniutto
  fullname: Toniutto, Pierluigi
  organization: Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy
– sequence: 7
  givenname: Beatriz
  surname: Mínguez
  fullname: Mínguez, Beatriz
  organization: Liver Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
– sequence: 8
  givenname: Valentina
  surname: Cacciato
  fullname: Cacciato, Valentina
  organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
– sequence: 9
  givenname: Claudio
  surname: Avellini
  fullname: Avellini, Claudio
  organization: Institute of Histopathology, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Udine, Italy
– sequence: 10
  givenname: Alba
  surname: Diaz
  fullname: Diaz, Alba
  organization: Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic, University of Barcelona, Barcelona, Spain
– sequence: 11
  givenname: Rosemary J.
  surname: Boyton
  fullname: Boyton, Rosemary J.
  organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
– sequence: 12
  givenname: Daniel M.
  surname: Altmann
  fullname: Altmann, Daniel M.
  organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
– sequence: 13
  givenname: Robert D
  surname: Goldin
  fullname: Goldin, Robert D
  organization: Centre for Pathology, Imperial College London, London, UK
– sequence: 14
  givenname: Ayse U
  surname: Akarca
  fullname: Akarca, Ayse U
  organization: Department of Histopathology, University College London Cancer Institute, London, UK
– sequence: 15
  givenname: Teresa
  surname: Marafioti
  fullname: Marafioti, Teresa
  organization: Department of Histopathology, University College London Cancer Institute, London, UK
– sequence: 16
  givenname: Francesco A
  surname: Mauri
  fullname: Mauri, Francesco A
  organization: Department of Surgery and Cancer, Imperial College London, London, UK
– sequence: 17
  givenname: Edoardo
  surname: Casagrande
  fullname: Casagrande, Edoardo
  organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
– sequence: 18
  givenname: Federica
  surname: Grillo
  fullname: Grillo, Federica
  organization: Department of Surgical Sciences, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
– sequence: 19
  givenname: Edoardo
  surname: Giannini
  fullname: Giannini, Edoardo
  organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
– sequence: 20
  givenname: Sherrie
  surname: Bhoori
  fullname: Bhoori, Sherrie
  organization: Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
– sequence: 21
  givenname: Vincenzo
  surname: Mazzaferro
  fullname: Mazzaferro, Vincenzo
  organization: Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34593621$$D View this record in MEDLINE/PubMed
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Keywords liver neoplasms
immunotherapy
Language English
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Snippet BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell...
Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function...
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StartPage e003311
SubjectTerms Adult
Aged
Apoptosis
Cancer
Cancer therapies
Carcinoma, Hepatocellular - drug therapy
Carcinoma, Hepatocellular - pathology
Cell death
Chemoembolization
Chemoembolization, Therapeutic - methods
Chemotherapy
Clinical trials
Clinical/Translational Cancer Immunotherapy
Cytotoxicity
Embolization
Female
Gene expression
Humans
Immunogenic Cell Death - drug effects
Immunotherapy
Immunotherapy - methods
Ligands
Liver cancer
liver neoplasms
Liver Neoplasms - drug therapy
Liver Neoplasms - pathology
Male
Middle Aged
Patients
Surgery
Tumors
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Title Trans-arterial chemoembolization as a loco-regional inducer of immunogenic cell death in hepatocellular carcinoma: implications for immunotherapy
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