GENE EXPRESSION BASED BIOMARKER OF TUMOR RESPONSE TO PD-1 ANTAGONISTS
The invention relates to a stromal/EMT/TGFβ signature that is predictive of patient response to treatment with a PD-1 antagonist, wherein the stromal/EMT/TGFβ signature comprises five or more genes selected from Table 1 disclosed herein. More specifically, a lower stromal/EMT/TGF-β score is associated with favorable response to a PD-1 antagonist in a patient with cancer. Also provided are methods of treating a cancer patient with a PD-1 antagonist that were identified as positive for the stromal/EMT/TGFβ biomarker of the invention. The disclosure also provides methods and kits for testing tumor samples for the biomarkers.
1 . A method for testing a tumor for the presence or absence of a biomarker that predicts response to treatment with a PD-1 antagonist, which comprises:
(a) obtaining a sample from the tumor,
(b) measuring the raw RNA expression level in the tumor sample for each gene in a stromal/EMT/TGFβ gene signature, wherein the stromal/EMT/TGFβ gene signature comprises at least ten genes selected from the group consisting of: CD93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, KIAA1462, FAM26E, FILIP1L, and ELTD1;
(c) normalizing each of the measured raw RNA expression levels;
(d) calculating the arithmetic mean of the normalized RNA expression levels for each of the genes to generate a score for the stromal/EMT/TGFβ gene signature;
(e) comparing the calculated score to a reference score for the stromal/EMT/TGFβ gene signature; and
(f) classifying the tumor as biomarker positive or biomarker negative; wherein if the calculated score is equal to or less than the reference score, then the tumor is classified as biomarker positive, and if the calculated stromal/EMT/TGFβ gene signature score is greater than the reference stromal/EMT/TGFβ gene signature score, then the tumor is classified as biomarker negative.
2 . The method of claim 1 , wherein step (b) comprises normalizing each of the measured raw RNA levels for each gene in the stromal/EMT/TGFβ gene signature using the measured RNA levels of a set of normalization genes.
3 . The method of claim 2 , wherein the set of normalization genes comprises 10-12 housekeeping genes.
4 . The method of claim 3 , wherein the set of normalization genes comprises at least ten of the following genes: ABCF1, C14ORF102, G6PD, OAZ1, POLR2A, SDHA, STK11IP, TBC1D10B, TBP, UBB, and ZBTB34.
5 . A method for treating cancer in a subject having a tumor which comprises administering to the subject a PD-1 antagonist if the tumor is positive for a stromal/EMT/TGFβ gene signature biomarker, or administering to the subject a cancer treatment that does not include a PD-1 antagonist if the tumor is negative for the biomarker; wherein the determination of whether the tumor is positive or negative for the stromal/EMT/TGFβ gene signature biomarker was made using a method according to claim 1 .
6 . A method for treating cancer in a subject having a tumor which comprises:
(a) determining if the tumor is positive or negative for a stromal/EMT/TGFβ gene signature biomarker, wherein the determining step comprises:
(i) obtaining a sample from the subject's tumor;
(ii) sending the tumor sample to a laboratory with a request to test the sample for the presence or absence of the stromal/EMT/TGFβ gene signature biomarker; and
(iii) receiving a report from the laboratory that states whether the tumor sample is biomarker positive or biomarker negative, wherein the tumor sample is classified as biomarker positive or biomarker negative using a method according to claim 1 ; and
(b) administering to the subject a PD-1 antagonist if the tumor is positive for the biomarker, or administering to the subject a cancer treatment that does not include a PD-1 antagonist if the tumor is negative for the biomarker.
7 . A method for treating cancer in a subject having a tumor which comprises:
(a) determining if the tumor is positive or negative for a stromal/EMT/TGFβ gene signature biomarker, wherein the determining step comprises:
(i) obtaining a sample from the subject's tumor;
(ii) sending the tumor sample to a laboratory with a request to generate a stromal/EMT/TGFβ gene signature score;
(iii) receiving a report from the laboratory that states the stromal/EMT/TGFβ gene signature score, wherein the stromal/EMT/TGFβ gene signature score is generated by a method comprising:
(1) measuring the raw RNA expression level in the tumor sample for each gene in a stromal/EMT/TGFβ gene signature; wherein the stromal/EMT/TGFβ gene signature comprises at least ten genes selected from the group consisting of: CD93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, KIAA1462, FAM26E, FILIP1L, and ELTD;
(2) normalizing each of the measured raw RNA expression levels; and
(3) calculating the arithmetic mean of the normalized RNA expression levels for each of the genes to generate the score for the stromal/EMT/TGFβ gene signature;
(iv) comparing the calculated score to a reference score for the stromal/EMT/TGFβ gene signature; and
(v) classifying the tumor as biomarker positive or biomarker negative; wherein if the calculated score is equal to or less than the reference score, then the tumor is classified as biomarker positive, and if the calculated stromal/EMT/TGFβ gene signature score is greater than the reference stromal/EMT/TGFβ gene signature score, then the tumor is classified as biomarker negative; and
(b) administering to the subject a PD-1 antagonist if the tumor is positive for the biomarker, or administering to the subject a cancer treatment that does not include a PD-1 antagonist if the tumor is negative for the biomarker.
8 . The method of claim 7 , wherein step (a)(iii)(2) comprises normalizing each of the measured raw RNA levels for each gene in the stromal/EMT/TGFβ gene signature using the measured RNA levels of a set of normalization genes.
9 . The method of claim 8 , wherein the normalization set comprises 10-12 housekeeping genes.
10 . The method of claim 9 , wherein the normalization set comprises at least 10 of the following genes: ABCF1, C14ORF102, G6PD, OAZ1, POLR2A, SDHA, STK11IP, TBC1D10B, TBP, UBB, and ZBTB34.
11 . The method of claim 1 , wherein the stromal/EMT/TGFβ gene signature comprises the following genes: CD 93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, and ELTD1.
12 . A method for treating cancer in a subject having a tumor which comprises:
(a) determining or having determined if the tumor is positive or negative for a stromal/EMT/TGFβ gene signature biomarker using the method according to claim 1 ;
(b) determining or having determined if the tumor is positive or negative for a T-cell inflamed gene expression profile (GEP) gene signature biomarker; which step comprises:
(i) measuring the raw RNA expression level in the tumor sample for each gene in the T-cell inflamed GEP gene signature; wherein the T-cell inflamed GEP gene signature comprises 10 or more genes selected from the group consisting of: TIGIT, CD27, CD8A, PDCD1LG2, LAG3, CD274, CXCR6, CMKLR1, NKG7, CCL5, PSMB10, IDO1, CXCL9, HLA.DQA1, CD276, STAT1, HLA.DRB1, and HLA.E;
(ii) normalizing each of the measured raw RNA expression levels;
(iii) calculating the arithmetic mean of the normalized RNA expression levels for each of the genes to generate a score for the T-cell inflamed GEP gene signature; and
(iv) classifying the tumor as biomarker positive or biomarker negative; wherein if the calculated T-cell inflamed GEP score is equal to or greater than a reference T-cell inflamed GEP score, then the tumor is classified as biomarker positive, and if the calculated T-cell inflamed GEP score is less than the reference T-cell inflamed GEP score, then the tumor is classified as biomarker negative; and
(c) administering to the subject a PD-1 antagonist if the tumor is positive for the stromal/EMT/TGFβ gene signature biomarker and positive for the T-cell inflamed GEP gene signature biomarker, or administering to the subject a cancer treatment that does not include a PD-1 antagonist if the tumor is negative for the stromal/EMT/TGFβ gene signature biomarker or negative for the T-cell inflamed GEP gene signature biomarker.
13 . The method of claim 5 , wherein the PD-1 antagonist is pembrolizumab, nivolumab, atezolizumab, durvalumab, cemiplimab, or avelumab.
14 . The method of claim 5 , wherein the PD-1 antagonist is pembrolizumab or a variant of pembrolizumab.
15 . A pharmaceutical composition comprising a PD-1 antagonist for use in a subject who has a tumor that tests positive for a stromal/EMT/TGFβ gene signature biomarker, wherein the stromal/EMT/TGFβ 1 gene signature comprises at least ten genes selected from the group consisting of: CD93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, KIAA1462, FAM26E, FILIP1L, and ELTD1.
16 . A drug product which comprises a pharmaceutical composition and prescribing information, wherein the pharmaceutical composition comprises a PD-1 antagonist and at least one pharmaceutically acceptable excipient and the prescribing information states that the pharmaceutical composition is indicated for use in a subject who has a tumor that tests positive for a stromal/EMT/TGFβ gene signature gene signature biomarker, wherein the stromal/EMT/TGFβ 1 gene signature comprises at least ten genes selected from the group consisting of: CD93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, KIAA1462, FAM26E, FILIP1L, and ELTD1.
17 . The pharmaceutical composition of claim 15 , wherein the positive biomarker test result was generated by a method according to claim 1 .
18 . A kit for assaying a tumor sample to determine a stromal/EMT/TGFβ gene signature score for the tumor sample, wherein the kit comprises a set of probes for detecting expression of each gene in the stromal/EMT/TGFβ gene signature, wherein the stromal/EMT/TGFβ gene signature comprises at least ten genes selected from the group consisting of: CD93, AEBP1, CDH11, COL1A2, COL5A2, ECM2, PDGFRB, CD248, GGT5, MSRB3, THBS2, GLT8D2, LRRC32, OLFML1, COL3A1, ANGPTL2, DCN, HEG1, GPR124, ADAMTS2, THY1, CRISPLD2, WISP1, COL15A1, ANTXR1, COL6A2, COL8A1, NID2, PCOLCE, AXL, PODN, FBN1, ITGA11, OLFML2B, COL5A1, EDNRA, LAMA4, CCDC80, VCAN, MXRA8, SPARC, TSHZ3, RUNX1T1, FSTL1, MMP2, HSPA12B, COL6A3, KIAA1462, FAM26E, FILIP1L, and ELTD1.
19 . The method of claim 5 , wherein the cancer is melanoma, non-small cell lung cancer, small cell lung cancer, head and neck squamous cell cancer, Hodgkin lymphoma, primary mediastinal large B-cell lymphoma, urothelial carcinoma, microsatellite instability-high cancer, gastric cancer, cervical cancer, renal cell carcinoma, esophageal cancer, Merkel cell carcinoma, endometrial cancer, or hepatocellular carcinoma.
20 . The method of claim 5 , wherein the cancer is locally advanced or metastatic urothelial carcinoma.