Journal for ImmunoTherapy of Cancer (Sep 2019)

Clinical and immune profiling for cancer of unknown primary site

  • Koji Haratani,
  • Hidetoshi Hayashi,
  • Takayuki Takahama,
  • Yasushi Nakamura,
  • Shuta Tomida,
  • Takeshi Yoshida,
  • Yasutaka Chiba,
  • Takahiro Sawada,
  • Kazuko Sakai,
  • Yoshihiko Fujita,
  • Yosuke Togashi,
  • Junko Tanizaki,
  • Hisato Kawakami,
  • Akihiko Ito,
  • Kazuto Nishio,
  • Kazuhiko Nakagawa

DOI
https://doi.org/10.1186/s40425-019-0720-z
Journal volume & issue
Vol. 7, no. 1
pp. 1 – 12

Abstract

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Abstract Background Immune checkpoint inhibitors (ICIs) confer a survival benefit in many cancer types. Given that the survival outcome for cancer of unknown primary site (CUP) remains poor, we investigated the potential of CUP for immunotherapy. Methods A total of 164 patients with CUP (favorable subset, 34 patients; unfavorable subset, 130 patients) who were treated between January 2009 and March 2017 was identified from a review of medical records at Kindai University Hospital. They included 92 patients for whom pretreatment tumor tissue was available both for determination of programmed cell death–ligand 1 expression and tumor-infiltrating lymphocyte (TIL) density by immunohistochemistry (IHC) and for immune-related gene expression profiling (irGEP). The results of irGEP for CUP were compared with published data for ICI-treated solid cancers classified into progressive disease (PD) and non-PD subsets according to their best response to ICIs. Results The median overall survival of all CUP patients was 29.3 months (95% confidence interval [CI], 15.7–not reached) and 7.1 months (95% CI, 5.0–9.4) for favorable and unfavorable subsets, respectively. IHC and irGEP revealed that pretreatment immune activity—including expression of immune checkpoint molecules—for CUP was similar to that for ICI-responsive malignancies (antitumor immune cell signatures: CUP versus PD, P = 0.002–0.067; CUP versus non-PD, P = 0.591–0.999), although VEGFA expression was associated with suppression of antitumor immunity in CUP (P = 0.008, false discovery rate = 0.010). In addition, one case of CUP in the unfavorable subset that was associated with prominent PD-L1 expression on TILs and showed a durable response to nivolumab is presented. Conclusions The survival outcome of CUP remains unsatisfactory. However, our clinical and immune profiling of CUP has revealed a potential to benefit from immunotherapy, with ICIs thus being a potential option for CUP treatment.

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