Preclinical MD Anderson study opens the door for exploring immunotherapy in colon cancer prevention.
The findings, published in JAMA Oncology, will be presented today at the American Association for Cancer Research Annual Meeting 2018 in Chicago by Kyle Chang, graduate research assistant. Immune checkpoint inhibitors targeting PD-1, such as pembrolizumab and nivolumab, have been successful in treating colorectal cancers with deficiencies in DNA mismatch repair (MMR). These tumors accumulate large numbers of genetic mutations and mutant proteins, or neoantigens, which are thought to stimulate an immune response, making them more susceptible to checkpoint blockade therapy.
"Our question was how this worked in premalignancy," said senior author Eduardo Vilar-Sanchez, M.D., Ph.D., assistant professor of Clinical Cancer Prevention and Gastrointestinal (GI) Medical Oncology. "Can we apply checkpoint inhibitors or checkpoint inhibitor strategies to prevent MMR-deficient colorectal cancer?" Lynch syndrome (LS), which is caused by inherited mutations in MMR, provides the perfect context in which to study early immune activation and explore the potential use of checkpoint inhibitors in a prevention setting, explained Vilar-Sanchez. Over 1 million people in the U.S. are affected by LS, the most common hereditary colorectal cancer syndrome.
"To our surprise, our findings don't follow the standard model. The majority of premalignant lesions do not have an excessive increase in mutations or neoantigens," said Vilar-Sanchez. "However, we observed there is already immune activation, meaning the activation precedes the development of the mutations." The findings suggest a baseline level of immune activation exists in precancerous polyps, which may prime them for susceptibility to checkpoint blockade, explained Vilar-Sanchez.
Future work will be necessary to clarify the mechanism by which this immune activation occurs, as the current study was observational in nature. The researchers hope to initiate clinical studies to investigate the use of checkpoint blockade strategies for preventing colorectal cancer in high-risk groups, such as those with LS. "Lynch syndrome patients have a strong immune activation in the colon, and that immune activation can be exploited for preventive purposes," said Vilar-Sanchez. "I think our data provide the information needed to launch studies to use checkpoint inhibition in the setting of prevention."