Pathway-flux based biomarker for immunotherapy response in melanoma.
e22064 Background: Immune checkpoint therapy (ICT) refers to therapeutic interventions that specifically target immune evasion mechanisms to restore the host immunity with anti-tumor ability. The ICT has revolutionized the immune-based treatment across > 30 different cancers including solid tumors and hematopoietic malignancies, with an ORR of 30% and a 7%-12% grades 3-5 irAEs in average. However, a substantial unmet point is the development of a biomarker with which response of ICT can be predicted before treatment for individual patients. Methods: In order to face this challenge this study developed an advanced genome-scale pathway flux analysis (GPFA) to evaluate the strength of signaling transduction and metabolic flux in immune system. The input of GPFA is the gene expression profiles of individual objects and the output of GPFA can be summarized in a index system, IM.Index, with following definition: IM.Index = 1.78E-4 * Σ flux(P) + 2.37E-4 * Σ flux(P) p ∈ signaling transduction p ∈ energy metabolism. Subsequently, the IM.Index was applied to analyze genetic data of two independent cohorts of melanoma patients treated with anti-PD-1 therapy (nivolumab a. pembrolizumab). Results: The IM.Index predicted the response of anti-PD-1 therapy (nivolumab) in the first cohort with an odds ratio (OR) of 3.14 (95%CI: 1.16-8.45; p = 3.10E-3; AUC = 0.82) and with a sensitivity 89% and specificity 76%. The prediction on overall survival (OS) of this cohort achieved an hazard ratio (HR) of 1.53 (95%CI: 1.22-1.92; p = 7.8E-3). Subsequently, the prediction result for the anti-PD-1 therapy (pembrolizumab) in the second cohort achieved an OR of 2.12 (95%CI: 1.22-3.66; p = 4.50E-4; AUC = 0.87) and the OS prediction in this cohort reached an HR of 1.24 (95%CI: 1.04-1.47; p = 1.40E-2). Comparison with other four potential biomarkers (TMB, TNB, neo-peptide load and cytolytic score) related to immunotherapy showed a comparative outcome of the IM.Index regarding diagnosis and prognosis in melanoma. For instance, IM.Index showed a superior performance on objective response rate (ORR) of 70% and AUC of 0.83. Conclusions: In conclusion this study demonstrated that a pathway flux analysis at a genome-scale may be explorative in biomarker research in immunotherapy, since this type of analysis could reflect the strength or functional status of the immune system. The IM.Index developed in this study may also be applied to investigation the treatment response of immunotherapy in other types of cancer.