Multicenter validation of an RNA-based assay to predict anti-PD-1 disease control in patients with recurrent or metastatic head and neck squamous cell carcinoma: The PREDAPT study

Kevin C. Flanagan, Jon Earls, Jeffrey Hiken, Rachel L. Wellinghoff, Michelle M. Ponder, Howard L. McLeod, William H. Westra, Vera Vavinskaya, Leisa Sutton, Ida Deichaite, Orlan K. Macdonald, Karim Welaya, James Wade, Georges Azzi, Andrew W. Pippas, Jennifer Slim, Bruce Bank, Xingwei Sui, Steven E. Kossman, Todd D. ShenkenbergWarren L. Alexander, Katharine A. Price, Jessica Ley, David N. Messina, Jarret I. Glasscock, A. Dimitrios Colevas, Ezra E.W. Cohen, Douglas Adkins, Eric J. Duncavage

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Abstract

Background Despite advances in cancer care and detection, >65% of patients with squamous cell cancer of the head and neck (HNSCC) will develop recurrent and/or metastatic disease. The prognosis for these patients is poor with a 5-year overall survival of 39%. Recent treatment advances in immunotherapy, including immune checkpoint inhibitors like pembrolizumab and nivolumab, have resulted in clinical benefit in a subset of patients. There is a critical clinical need to identify patients who benefit from these antiprogrammed cell death protein 1 (anti-PD-1) immune checkpoint inhibitors. Methods Here, we report findings from a multicenter observational study, PREDicting immunotherapy efficacy from Analysis of Pre-treatment Tumor biopsies (PREDAPT), conducted across 17 US healthcare systems. PREDAPT aimed to validate OncoPrism-HNSCC, a clinical biomarker assay predictive of disease control in patients with recurrent or metastatic HNSCC treated with anti-PD-1 immune checkpoint inhibitors as a single agent (monotherapy) and in combination with chemotherapy (chemo-immunotherapy). The test used RNA-sequencing data and machine learning models to score each patient and place them into groups of low, medium, or high. Results The OncoPrism-HNSCC prediction significantly correlated with disease control in both the monotherapy cohort (n=62, p=0.004) and the chemo-immunotherapy cohort (n=50, p=0.01). OncoPrism-HNSCC also significantly predicted progression-free survival in both cohorts (p=0.015 and p=0.037, respectively). OncoPrism-HNSCC had more than threefold higher specificity than programmed death-ligand 1 combined positive score and nearly fourfold higher sensitivity than tumor mutational burden for predicting disease control. Conclusions Here, we demonstrate the clinical validity of the OncoPrism-HNSCC assay in identifying patients with disease control in response to anti-PD-1 immune checkpoint inhibitors. Trial registration number NCT04510129.

Original languageEnglish
Article numbere009573
JournalJournal for ImmunoTherapy of Cancer
Volume12
Issue number11
DOIs
StatePublished - Nov 3 2024

Keywords

  • biomarker
  • head and neck cancer
  • immune checkpoint inhibitor
  • next generation sequencing (NGS)
  • tumor mutation burden (TMB)

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