Mutations Associated With Acquired Resistance to PD-1 Blockade in Melanoma

N Engl J Med. 2016 Sep 1;375(9):819-29. doi: 10.1056/NEJMoa1604958. Epub 2016 Jul 13.

Abstract

Background: Approximately 75% of objective responses to anti-programmed death 1 (PD-1) therapy in patients with melanoma are durable, lasting for years, but delayed relapses have been noted long after initial objective tumor regression despite continuous therapy. Mechanisms of immune escape in this context are unknown.

Methods: We analyzed biopsy samples from paired baseline and relapsing lesions in four patients with metastatic melanoma who had had an initial objective tumor regression in response to anti-PD-1 therapy (pembrolizumab) followed by disease progression months to years later.

Results: Whole-exome sequencing detected clonal selection and outgrowth of the acquired resistant tumors and, in two of the four patients, revealed resistance-associated loss-of-function mutations in the genes encoding interferon-receptor-associated Janus kinase 1 (JAK1) or Janus kinase 2 (JAK2), concurrent with deletion of the wild-type allele. A truncating mutation in the gene encoding the antigen-presenting protein beta-2-microglobulin (B2M) was identified in a third patient. JAK1 and JAK2 truncating mutations resulted in a lack of response to interferon gamma, including insensitivity to its antiproliferative effects on cancer cells. The B2M truncating mutation led to loss of surface expression of major histocompatibility complex class I.

Conclusions: In this study, acquired resistance to PD-1 blockade immunotherapy in patients with melanoma was associated with defects in the pathways involved in interferon-receptor signaling and in antigen presentation. (Funded by the National Institutes of Health and others.).

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Biopsy
  • Drug Resistance, Neoplasm / genetics*
  • Exome
  • Gene Expression Regulation, Neoplastic
  • Genes, MHC Class I
  • Humans
  • Immunotherapy*
  • Interferon-gamma / therapeutic use
  • Janus Kinase 1 / genetics*
  • Janus Kinase 2 / genetics*
  • Melanoma / drug therapy
  • Melanoma / genetics*
  • Melanoma / secondary
  • Mutation*
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors*
  • Programmed Cell Death 1 Receptor / metabolism
  • Recurrence
  • Sequence Analysis, DNA
  • Signal Transduction
  • beta 2-Microglobulin / genetics*

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • PDCD1 protein, human
  • Programmed Cell Death 1 Receptor
  • beta 2-Microglobulin
  • Interferon-gamma
  • pembrolizumab
  • Janus Kinase 1
  • Janus Kinase 2