Immune activation and response to pembrolizumab in POLE-mutant endometrial cancer

J Clin Invest. 2016 Jun 1;126(6):2334-40. doi: 10.1172/JCI84940. Epub 2016 May 9.

Abstract

Antibodies that target the immune checkpoint receptor programmed cell death protein 1 (PD-1) have resulted in prolonged and beneficial responses toward a variety of human cancers. However, anti-PD-1 therapy in some patients provides no benefit and/or results in adverse side effects. The factors that determine whether patients will be drug sensitive or resistant are not fully understood; therefore, genomic assessment of exceptional responders can provide important insight into patient response. Here, we identified a patient with endometrial cancer who had an exceptional response to the anti-PD-1 antibody pembrolizumab. Clinical grade targeted genomic profiling of a pretreatment tumor sample from this individual identified a mutation in DNA polymerase epsilon (POLE) that associated with an ultramutator phenotype. Analysis of The Cancer Genome Atlas (TCGA) revealed that the presence of POLE mutation associates with high mutational burden and elevated expression of several immune checkpoint genes. Together, these data suggest that cancers harboring POLE mutations are good candidates for immune checkpoint inhibitor therapy.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Carcinoma, Endometrioid / genetics
  • Carcinoma, Endometrioid / immunology
  • Carcinoma, Endometrioid / therapy
  • DNA Polymerase II / genetics*
  • Endometrial Neoplasms / genetics
  • Endometrial Neoplasms / immunology*
  • Endometrial Neoplasms / therapy*
  • Female
  • Humans
  • Middle Aged
  • Mutation*
  • Poly-ADP-Ribose Binding Proteins
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • Programmed Cell Death 1 Receptor / immunology

Substances

  • Antibodies, Monoclonal, Humanized
  • PDCD1 protein, human
  • Poly-ADP-Ribose Binding Proteins
  • Programmed Cell Death 1 Receptor
  • pembrolizumab
  • DNA Polymerase II
  • POLE protein, human