Supplementary Figure S14 from Autocrine 17-β-Estradiol/Estrogen Receptor-α Loop Determines the Response to Immune Checkpoint Inhibitors in Non–Small Cell Lung Cancer
posted on 2023-10-02, 07:41authored byDario P. Anobile, Iris C. Salaroglio, Fabrizio Tabbò, Sofia La Vecchia, Muhlis Akman, Francesca Napoli, Maristella Bungaro, Federica Benso, Elisabetta Aldieri, Paolo Bironzo, Joanna Kopecka, Francesco Passiglia, Luisella Righi, Silvia Novello, Giorgio V. Scagliotti, Chiara Riganti
<p>Effects of letrozole on the efficacy of chemo-immuno-therapy in non-small cell lung cancer xenografts.
1×106 female-derived ERα lowNCI-H1385 cells and ERα highNCI-H1975 cells, male-derived ERα lowA549 cells and ERα highNCI-H1650 cells were implanted subcutaneously (s.c.) in Hu-CD34+NSG mice. When tumors reached the volume of 100 mm3, mice (n= 5/group) were randomized in the following groups: 1) Vehicle group, treated intraperitoneally (i.p.) with 100 µl saline solution (days 1, 7, 14, 21, 28, 35 after randomization); 2) cisplatin (PT) group, treated with 2 mg/kg intravenously (i.v.) (days 7, 14, 21, 28, 35); 3) cisplatin + pembrolizumab (PT+Pemb) group, treated with 2 mg/kg cisplatin i.v. (days 7, 14, 21, 28, 35) and 10 mg/kg i.p. of 100 µl saline solution of pembrolizumab (day 1) followed by 5 mg/kg i.p. (days 7, 14, 21, 28, 35); 4) cisplatin + pembrolizumab + letrozole (PT+Pemb+Letr) group, treated with 2 mg/kg cisplatin i.v. (days 7, 14, 21, 28, 35), 10 mg/kg i.p. of 100 µl saline solution of pembrolizumab (day 1) followed by 5 mg/kg i.p. (days 7, 14, 21, 28, 35) and 1 mg/kg per os of 100 µl saline solution of letrozole daily (days 1-35). Tumor growth was monitored daily with a caliper. Mice were euthanized on day 40. Data are mean volumes+SD. **p<0.01, ***p<0.001: treatments group versus Vehicle group (day 40); °°°p<0.001: PT+Pemb+Letr group versus Pemb+Letr group (day 40; ANOVA).</p>
Funding
Fondazione AIRC per la ricerca sul cancro ETS (AIRC)
Cassa di Risparmio di Torino
Compagnia di San Paolo (CSP)
European Cooperation in Science and Technology (COST)
The response to immune checkpoint inhibitors (ICI) often differs between genders in non–small cell lung cancer (NSCLC), but metanalyses results are controversial, and no clear mechanisms are defined. We aim at clarifying the molecular circuitries explaining the differential gender-related response to anti–PD-1/anti–PD-L1 agents in NSCLC.
We prospectively analyzed a cohort of patients with NSCLC treated with ICI as a first-line approach, and we identified the molecular mechanisms determining the differential efficacy of ICI in 29 NSCLC cell lines of both genders, recapitulating patients’ phenotype. We validated new immunotherapy strategies in mice bearing NSCLC patient-derived xenografts and human reconstituted immune system (“immune-PDXs”).
In patients, we found that estrogen receptor α (ERα) was a predictive factor of response to pembrolizumab, stronger than gender and PD-L1 levels, and was directly correlated with PD-L1 expression, particularly in female patients. ERα transcriptionally upregulated CD274/PD-L1 gene, more in females than in males. This axis was activated by 17-β-estradiol, autocrinely produced by intratumor aromatase, and by the EGFR-downstream effectors Akt and ERK1/2 that activated ERα. The efficacy of pembrolizumab in immune-PDXs was significantly improved by the aromatase inhibitor letrozole, which reduced PD-L1 and increased the percentage of antitumor CD8+T-lymphocytes, NK cells, and Vγ9Vδ2 T-lymphocytes, producing durable control and even tumor regression after continuous administration, with maximal benefit in 17-β-estradiol/ERα highfemale immune-xenografts.
Our work unveils that 17-β-estradiol/ERα status predicts the response to pembrolizumab in patients with NSCLC. Second, we propose aromatase inhibitors as new gender-tailored immune-adjuvants in NSCLC.See related commentary by Valencia et al., p. 3832