MHC proteins confer differential sensitivity to CTLA-4 and PD-1 blockade in untreated metastatic melanoma

SJ Rodig, D Gusenleitner, DG Jackson… - Science translational …, 2018 - science.org
SJ Rodig, D Gusenleitner, DG Jackson, E Gjini, A Giobbie-Hurder, C Jin, H Chang…
Science translational medicine, 2018science.org
Combination anti–cytotoxic T lymphocyte antigen 4 (CTLA-4) and anti–programmed cell
death protein 1 (PD-1) therapy promotes antitumor immunity and provides superior benefit to
patients with advanced-stage melanoma compared with either therapy alone. T cell
immunity requires recognition of antigens in the context of major histocompatibility complex
(MHC) class I and class II proteins by CD8+ and CD4+ T cells, respectively. We examined
MHC class I and class II protein expression on tumor cells from previously untreated …
Combination anti–cytotoxic T lymphocyte antigen 4 (CTLA-4) and anti–programmed cell death protein 1 (PD-1) therapy promotes antitumor immunity and provides superior benefit to patients with advanced-stage melanoma compared with either therapy alone. T cell immunity requires recognition of antigens in the context of major histocompatibility complex (MHC) class I and class II proteins by CD8+ and CD4+ T cells, respectively. We examined MHC class I and class II protein expression on tumor cells from previously untreated melanoma patients and correlated the results with transcriptional and genomic analyses and with clinical response to anti–CTLA-4, anti–PD-1, or combination therapy. Most (>50% of cells) or complete loss of melanoma MHC class I membrane expression was observed in 78 of 181 cases (43%), was associated with transcriptional repression of HLA-A, HLA-B, HLA-C, and B2M, and predicted primary resistance to anti–CTLA-4, but not anti–PD-1, therapy. Melanoma MHC class II membrane expression on >1% cells was observed in 55 of 181 cases (30%), was associated with interferon-γ (IFN-γ) and IFN-γ–mediated gene signatures, and predicted response to anti–PD-1, but not anti–CTLA-4, therapy. We conclude that primary response to anti–CTLA-4 requires robust melanoma MHC class I expression. In contrast, primary response to anti–PD-1 is associated with preexisting IFN-γ–mediated immune activation that includes tumor-specific MHC class II expression and components of innate immunity when MHC class I is compromised. The benefits of combined checkpoint blockade may be attributable, in part, to distinct requirements for melanoma-specific antigen presentation to initiate antitumor immunity.
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