Functional systemic CD 4 immunity is required for clinical responses to PD‐L1/PD‐1 blockade therapy

M Zuazo, H Arasanz, G Fernández‐Hinojal… - EMBO molecular …, 2019 - embopress.org
M Zuazo, H Arasanz, G Fernández‐Hinojal, MJ García‐Granda, M Gato, A Bocanegra…
EMBO molecular medicine, 2019embopress.org
The majority of lung cancer patients progressing from conventional therapies are refractory
to PD‐L1/PD‐1 blockade monotherapy. Here, we show that baseline systemic CD 4
immunity is a differential factor for clinical responses. Patients with functional systemic CD 4
T cells included all objective responders and could be identified before the start of therapy
by having a high proportion of memory CD 4 T cells. In these patients, CD 4 T cells
possessed significant proliferative capacities, low co‐expression of PD‐1/LAG‐3 and were …
Abstract
The majority of lung cancer patients progressing from conventional therapies are refractory to PD‐L1/PD‐1 blockade monotherapy. Here, we show that baseline systemic CD4 immunity is a differential factor for clinical responses. Patients with functional systemic CD4 T cells included all objective responders and could be identified before the start of therapy by having a high proportion of memory CD4 T cells. In these patients, CD4 T cells possessed significant proliferative capacities, low co‐expression of PD‐1/LAG‐3 and were responsive to PD‐1 blockade ex vivo and in vivo. In contrast, patients with dysfunctional systemic CD4 immunity did not respond even though they had lung cancer‐specific T cells. Although proficient in cytokine production, CD4 T cells in these patients proliferated very poorly, strongly co‐upregulated PD‐1/LAG‐3, and were largely refractory to PD‐1 monoblockade. CD8 immunity only recovered in patients with functional CD4 immunity. T‐cell proliferative dysfunctionality could be reverted by PD‐1/LAG‐3 co‐blockade. Patients with functional CD4 immunity and PD‐L1 tumor positivity exhibited response rates of 70%, highlighting the contribution of CD4 immunity for efficacious PD‐L1/PD‐1 blockade therapy.
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