Best of WCLC 2016 Biomarqueurs associés aux immunothérapies

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1 Best of WCLC 2016 Biomarqueurs associés aux immunothérapies Julien Adam, MD PhD Département de Biologie et pathologie médicales Gustave Roussy, Villejuif 1

2 Testing PD-L1 Contexte moléculaire Autres biomarqueurs: charge mutationnelle, infiltrat immunitaire 2

3 Disclosures (J. Adam): Consultant/advisor: AstraZeneca, Bristol Myers Squibb, MSD, Roche, HalioDx. 3

4 Testing PD-L1 4

5 PD-L1 PD-L1 is an immune checkpoint molecule that negatively regulates T cell function Binding of PD-L1 to its receptors on activated T cells can inhibit tumor cell killing PD-L1 expressed on tumor cells and tumorinfiltrating cells can inhibit antitumor T cell response Zou, Nat Rev Immunol 2008; Chen, Immunity 2013; Herbst, Nature 2014; Powles, Nature

6 Tests PD-L1 utilisés dans les essais cliniques 6

7 Qualité du marquage Lecture par le pathologiste Rendu du résultat Courtesy MS Tsao 7

8 Problématiques Disponibilité des plateformes Dako/Ventana Taille des prélèvements Test unique Coût des tests Disponibilité rapide (première ligne++) : testing local Les tests utilisés dans les essais cliniques sont-ils comparables +/-interchangeables? Peut-on utiliser des tests maisons (laboratory-developped tests)?

9 Principales études comparatives Blueprint study (USA) publiée (phase 1) Hirsch et al. JTO 2016 German ring trial publiée (phase 1) Scheel et al. Mod Pathol 2016 Etude de concordance AstraZeneca poster AACR 2016 Etude française multicentrique présentation orale WCLC 2016 Etude du NCCN (USA) en cours de publication

10 PD-L1 IHC assays for lung cancer: results from phase 1 of the Blueprint PD-L1 assay comparison project Analytical comparison 22C3, 28-8, SP263 assays demonstrate similar analytical performance with respect to percentages of tumor cells positive and dynamic range All assays label immune cells but there is less precision in analytical performance than with tumor cell labeling Blueprint project (feasibility phase), Hirsch et al., AACR 2016

11 German ring trial 15 cases 4 assays (22C3, 28-8, SP142, SP263) LDT for E1L3N et SP142 on Leica platform 9 pathologists (concordance) Simplified score or TC and IC TC: thresholds 1, 5, 10, 25, 50% Stainings: - TC: lower percentage stained with SP142 - IC: higher intensity of staining with SP142 and SP263 Interobserver concordance Scheel et al. Mod Pathol 2016

12 500 cases (TMA) 3 kits (22C3, 28-8, SP263) 1 pathologist from AstraZeneca Tumor cells only AstraZeneca concordance study Conclusion: - High concordance rates between the tests (>90% for various thresholds) OPA: overall percentage agreement NPA: negative percentage agreement PPA: positive percentage agreement Astra Zeneca concordance study, Ratcliffe et al., AACR 2016

13 4 antibodies: 22C3, 28-8, SP142, SP263 3 antibodies: 22C3, 28-8, SP263

14 Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer Julien Adam, Isabelle Rouquette, Diane Damotte, Cécile Badoual, Hélène Pinot-Roussel, Claire Danel, Aurélie Cazes, Francesca Damiola, Lucie Tixier, Frédérique Penault-Llorca, Nolwenn Le Stang and Sylvie Lantuéjoul PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

15 Disclosures (J. Adam): Consultant/advisor: AstraZeneca, Bristol Myers Squibb, MSD, Roche, HalioDx. Funding for the present study: Bristol Myers Squibb, Merck Sharp and Dohme Support for the present study: AstraZeneca, Roche PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

16 Aims To evaluate the analytical performance of 28-8, 22C3 and SP263 PD-L1 assays across various centers To determine if laboratory developed tests (LDT) can achieve an analytical performance close to PD-L1 assays in a set of NSCLC cases Further steps: How concordant is PD-L1 testing performed with different - Validation of selected LDT on larger cohorts antibodies - Evaluation of interobserver and on concordance different for PD-L1 platforms, expression assessment including laboratory - Recommendations for PD-L1 testing and reporting in France developed tests? PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

17 Material & methods 41 resected NSCLC selected to have various expression levels of PD-L1 IHC performed in 7 centers (3 with Dako AS Link 48, 2 with Ventana Benchmark Ultra and 2 with Leica Bond III) 22C3, 28-8, E1L3N, SP142, SP263 clones used in each center either as assays on dedicated platform (22C3, 28-8, SP263) or LDT Tonsil tissue and reference pictures from NSCLC cases stained with 28-8 and 22C3 assays were used as for LDT harmonization PD-L1 staining was scored for TC (%) and IC staining (%) 7 trained pathologists participated in the study; each case was scored by a single pathologist, blinded from center, antibody and platform used 35 PD-L1 stainings (30 protocols) performed on 41 cases (1435 slides) Presentation PL04.04a - Multicentric Number: Presentation French harmonization Title Presenting study for Author PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

18 Dako (28-8, 22C3) and Ventana (SP263) assays (tumor cells staining) / 22C3 / SP263 Weighted kappa concordance (1%, 50% thresholds) SP C3 Overall agreement for 50% threshold: 95.1% 0.81 Weighted kappa coefficient* = 0.75 was defined as the minimum concordance for LDT selection * categories: <1%, 1-49%, % PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

19 Examples of Dako (28-8, 22C3) and Ventana (SP263) assays PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

20 28-8 and 22C3 assays and LDT (tumor cells staining) C3 1 LDT on Ventana platform identified as concordant with 28-8 assay 2 LDT on Ventana platform identified as concordant with 22C3 assay Weighted kappa concordance: 1%, 50% thresholds PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

21 SP263 assay and LDT / SP142 and E1L3N LDT (tumor cells staining) SP263 SP142 E1L3N All 5 LDT (Dako and Leica platforms) were found concordant with SP263 assay 2 LDT on Leica platforms were found concordant with SP263 assay 4 LDT on Dako, Ventana and Leica platforms were found concordant with SP263 assay PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

22 Examples of comparison between assays and LDT Assays LDT PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

23 Immune cells Concordance for assays Weighted kappa coefficient: 4 categories (<1%, 1-4%, 5-9%, 10%) Poor concordance for assays as well as LDT - Intensity of staining? - Number of categories? - Intraobserver variability? SP C3 PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

24 Selection of LDT Weighted Kappa coefficient (tumor cells staining) Overall concordance for each antibody (weighted Kappa coefficient) Selected LDT: - Dako: E1L3N, SP263 - Ventana: 28-8, 22C3, E1L3N - Leica: E1L3N, SP142, SP263 PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

25 Take-home messages 22C3, 28-8 and SP263 assays performed in several centers were highly concordant Among 27 LDT developed in 7 centers on Dako, Ventana and Leica platforms, 14 (51.8%) demonstrated similar concordance as compared to reference assays for tumor cell staining Low concordance was observed for immune cells staining when using a 4- categories scale with 1%, 5% and 10% thresholds Clone SP263 achieved the highest concordance rate across all platforms PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al.

26 Perspectives Caution is required for validation and further use of LDT Selected LDT will be validated on larger cohorts and by external quality assessment (EQA) programs in France These results will provide basis for national recommendations on PD-L1 testing in NSCLC PL04.04a - Multicentric French harmonization study for PD-L1 IHC testing in non-small cell lung cancer J. Adam et al. 26

27 Tests PD-L1: messages Les tests (kits) 28-8, 22C3 et SP163 sont très concordants pour le marquage des cellules tumorales et probablement interchangeables Les tests développés à partir des anticorps concentrés peuvent être utilisés mais avec précautions Recommendations à fournir : protocoles, validation Formation des pathologistes en cours

28 P : Paired Comparison of PD-L1 Assessment on Cytology and Histology from Malignancies in the Lung 28

29 Autres biomarqueurs 29

30 Mutations EGFR Contexte moléculaire Gainor, Clin Cancer Res 2016

31 Mutations KRAS - Tabagisme et comutation TP53 associés au bénéfice des anti-pd1 (avec expression de PD-L1, charge mutationnelle et infiltrat lymphocytaire T) - Comutation STK11/LKB1: moindre bénéfice des anti-pd1? Contexte moléculaire MA04.07: Impact of Major Co Mutations on the Immune Contexture and Response of KRAS Mutant Lung Adenocarcinoma to Immunotherapy Ferdinandos Skoulidis, The University of Texas M. D. Anderson Cancer Center, USA MA15.10: Potential Predictive Value of TP53 and KRAS Mutation Status for Response to PD 1 Blockade Immunotherapy in Lung Adenocarcinoma. Zhong Yi Dong, Guangdong Lung Cancer Institute, Guangdong General Hospital, China Dong, Clin Cancer Res 2016 Skoulidis, Clin Cancer Res 2015 Calles, J Thor Oncol 2015

32 Biomarqueurs des anti-pd1/pd-l1 Immunosuppressive pathways Inhibitory checkpoints: PD-L1, others Immunosuppressive immune cell populations (Treg, macrophages, ) Metabolic pathways (kynurenin) Tumor immunogenicity Mutational burden Neoantigens DNArepair defects: MSI T cell infiltration CD3+, CD8+ infiltrates IFNgamma Th1/IFN signatures Topalian, Nat Rev Cancer

33 Science 2015;348(6230): DCB: partial or stable response lasting >6 months NDB: No durable benefit High vs low mutation burden: median as cut-off 33

34 MA14.01 Updated Dataset Assessing Tumor Mutation Burden (TMB) as a Biomarker for Response to PD 1/PD L1 Targeted Therapies in Lung Cancer (LC) Siraj Ali, Foundation Medicine, USA 34

35 MA14.01 Updated Dataset Assessing Tumor Mutation Burden (TMB) as a Biomarker for Response to PD 1/PD L1 Targeted Therapies in Lung Cancer (LC) Siraj Ali, Foundation Medicine, USA 35

36 Impossible d afficher l image. Impossible d afficher l image. TMB vs response in NSCLC patients treated with ICPIs TMB 15 TMB < 15 TMB cutoff Median time on drug No. patients Log rank P-value Hazard Ratio 95% CI TMB weeks [0.190 TMB < weeks ] In a discovery set of 64 NSCLC cases treated with ICPIs, high TMB (>15 mut/mb) was associated with long time on drug The majority of these cases were from a single institution in a trial setting TMB >15 mutations/mb defines approximately the top quartile of NSCLC cases The diversity within population is striking however. Spigel et al., ASCO 2016, Abstract: 9017 MA14.01 Updated Dataset Assessing Tumor Mutation Burden (TMB) as a Biomarker for Response to PD 1/PD L1 Targeted Therapies in Lung Cancer (LC) Siraj Ali, Foundation Medicine, USA

37 Tumor mutation burden (TMB) is associated with improved efficacy of atezolizumab in 1L and 2L+ NSCLC patients Marcin Kowanetz, 1 Wei Zou, 1 David S. Shames, 1 Craig A. Cummings, 1 Naiyer Rizvi, 2 Alexander I. Spira, 3 Garrett M. Frampton, 4 Vincent Leveque, 1 Susan Flynn, 1 Simonetta Mocci, 1 Geetha Shankar, 1 Roel Funke, 1 Marcus Ballinger, 1 Daniel Waterkamp, 1 Daniel S. Chen, 1 Alan Sandler, 1 Garret Hampton, 1 Lukas C. Amler, 1 Priti S. Hegde, 1 Matthew D. Hellmann 5 1 Genentech, Inc., South San Francisco, CA; 2 Columbia University, New York, NY; 3 US Oncology Research, The Woodlands, TX; Virginia Cancer Specialists Research Institute, Fairfax, VA; 4 FoundationMedicine, Cambridge, MA; 5 Memorial Sloan Kettering Cancer Center, New York, NY Kowanetz et al., WCLC 2016

38 Association of TMB With Improved Response to Atezolizumab in 1L and 2L+ PD-L1 Selected Patients 40 1L Patients from BIRCH and FIR (PD-L1 selected) P = L+ Patients from BIRCH and FIR (PD-L1 selected) P = Mutations/MB Mutations/MB CR/PR SD PD CR/PR SD PD n = 22 n = 46 n = 19 n = 72 n = 122 n = Responses were assessed by RECIST v1.1. P value comparing TMB across atezolizumab response groups (CR/PR vs SD vs PD), was determined by Kruskal-Wallis test. The solid lines indicate the medians. CR, complete response; PD, progressive disease; PR, partial response; SD, stable disease. Kowanetz et al., WCLC 2016

39 TMB Associations with PD-L1 Expression and TIL infiltration TMB vs PD-L1 P = TMB vs TIL P = 0.54 PD-L1 Mutually Exclusive Subgroups (SP142 IHC) TIL Score (% of TILs/tumor area) TMB appears to be weakly associated with PD-L1 expression, but not with TIL infiltration Association with PD-L1 expression on TC and IC is consistent with TMB representing more immunogenic tumors TIL, tumor-infiltrating lymphocyte. Kowanetz et al., WCLC 2016

40 Response to Atezolizumab in the Context of PD-L1 Expression and TMB in 2L+ NSCLC TMB cut-off: PD-L1 Subgroup TC3 or IC3 (n = 169) < TMB cutoff TMB cutoff The highest ORR was observed in patients with both high PD-L1 expression and high TMB 9.9 mut/mb TC2 or IC2 (n = 173) TC1 or IC1 (n = 58) - This is consistent with a hypothesis that cancer immunotherapy is most active in highly immunogenic tumors with a pre-existing immunity TC0 and IC0 (n = 8) TC3 or IC3 (n = 169) 0% 0% Responses to atezolizumab were also observed in patients with low TMB 16.2 mut/mb TC2 or IC2 (n = 173) TC1 or IC1 (n = 58) No responses were observed in TC0 and IC0 population (n=8); results from a larger cohort are needed to confirm this observation TC0 and IC0 (n = 8) 0% 0% ORR (%) a a Includes all patients from the BIRCH (C2+C3), FIR (C2) and POPLAR trials except patients not treated with atezolizumab (n = 5) or receiving docetaxel (n = 52). Data from 1L patients not shown due to small n across subgroups. Kowanetz et al., WCLC 2016

41 Neoantigen Targeting in NSCLC Patients with Complete Response to Anti-PD-1 Immunotherapy Kellie N. Smith, Valsamo Anagnostou, Patrick Forde, Julie Brahmer, Victor E. Velculescu, Drew M. Pardoll The Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University School of Medicine Baltimore, MD Program Number 4352: Neoantigen targeting in NSCLC patients with complete response to anti-pd-1 immunotherapy Kellie N. Smith

42 Analysis of MANA reactivity in NSCLC patients receiving nivolumab Anagnostou et al, under review Program Number 4352: Neoantigen targeting in NSCLC patients with complete response to anti-pd-1 immunotherapy Kellie N. Smith

43 Conclusions CR to nivolumab achieved in patients with low mutational burden Activation of PD-1/PD-L1 axis regardless of mutational burden Peripheral MANA reactivity is long-lived Conventional detection methods may miss MANA reactivity MANA recognition in low mutational burden patients may be more prevalent than previously hypothesized -MANA targeting in low vs. high mutational burden patients may be different -Ongoing analyses to determine mechanisms of response in patients with low mutational burden Program Number 4352: Neoantigen targeting in NSCLC patients with complete response to anti-pd-1 immunotherapy Kellie N. Smith

44 Pas de corrélation MA15.01 Karasaki et al. Faible corrélation OA20.01 Kowanetz Pas de corrélation MA15.06 Gettinger et al. OA20.01Kowanetz et al. 44

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46 Biomarqueurs associés aux immunothérapies au WLCL 2016 Vers l harmonisation du testing PD-L1: - Tests 22C3, 28-8 et SP263 (Dako/Ventana) - Tests développés dans les laboratoires avec différents anticorps - Test PD-L1 SP142 pour l atezolizumab à part (marquage, scoring) - Utilisation sur échantillons de cytoponction Charge mutationnelle corrélée au bénéfice des immunothérapies anti-pd1/pdl1 mais le seuil est difficile à définir Corrélations et combinaisons des biomarqueurs : score prédictif? 46