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Supplementary Figure S13 from Resistance to Durvalumab and Durvalumab plus Tremelimumab Is Associated with Functional STK11 Mutations in Patients with Non–Small Cell Lung Cancer and Is Reversed by STAT3 Knockdown

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posted on 2023-04-03, 23:41 authored by Nabendu Pore, Song Wu, Nathan Standifer, Maria Jure-Kunkel, Melissa de los Reyes, Yashaswi Shrestha, Rebecca Halpin, Raymond Rothstein, Kathy Mulgrew, Stephen Blackmore, Philip Martin, John Meekin, Matthew Griffin, Ina Bisha, Theresa A. Proia, Ricardo J. Miragaia, Ronald Herbst, Ashok Gupta, Shaad E. Abdullah, Rajiv Raja, Melanie M. Frigault, J. Carl Barrett, Phillip A. Dennis, Maria Libera Ascierto, Michael D. Oberst

Suppressive activity of MDSCs isolated from CT26 WT or CT26 SKT11 KO tumors and pharmacological reversal by STAT3 ASO treatment in the CT26 WT model. (A) Percentage of naive T cell proliferation by anti-CD3/CD28/IL2 stimulation in the presence of Gr1+ MDSCs isolated from CT26 WT or CT26 STK11 KO tumors (left), as indicated. Error bars represent SEM from technical replicates of MDSCs pooled from multiple tumors. P-values calculated using two-tailed Student's T test. Proliferation of non-stimulated T cells and anti-CD3/CD28/IL2-stimulated T cells used as controls in the assay are also shown (right). (B) Percentage T cell proliferation when co-cultured with MDSCs from mice engrafted with CT26 WT tumors and administered either CPIs and/or STAT3 ASO, or isotype control antibodies, as indicated. The x-axis represents the MDSC:T cell ratio in the assay. The proliferation of the non-stimulated T cells and anti-CD3/CD28/IL2-stimulated T cells which were used as controls in the assay is also shown.

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ARTICLE ABSTRACT

Mutations in the STK11 (LKB1) gene regulate resistance to PD-1/PD-L1 blockade. This study evaluated this association in patients with nonsquamous non–small cell lung cancer (NSCLC) enrolled in three phase I/II trials. STK11 mutations were associated with resistance to the anti–PD-L1 antibody durvalumab (alone/with the anti-CTLA4 antibody tremelimumab) independently of KRAS mutational status, highlighting STK11 as a potential driver of resistance to checkpoint blockade. Retrospective assessments of tumor tissue, whole blood, and serum revealed a unique immune phenotype in patients with STK11 mutations, with increased expression of markers associated with neutrophils (i.e., CXCL2, IL6), Th17 contexture (i.e., IL17A), and immune checkpoints. Associated changes were observed in the periphery. Reduction of STAT3 in the tumor microenvironment using an antisense oligonucleotide reversed immunotherapy resistance in preclinical STK11 knockout models. These results suggest that STK11 mutations may hinder response to checkpoint blockade through mechanisms including suppressive myeloid cell biology, which could be reversed by STAT3-targeted therapy. Patients with nonsquamous STK11-mutant (STK11mut) NSCLC are less likely than STK11 wild-type (STK11wt) patients to respond to anti–PD-L1 ± anti-CTLA4 immunotherapies, and their tumors show increased expression of genes and cytokines that activate STAT3 signaling. Preclinically, STAT3 modulation reverses this resistance, suggesting STAT3-targeted agents as potential combination partners for immunotherapies in STK11mut NSCLC.This article is highlighted in the In This Issue feature, p. 2659

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