Elucidating the Heterogeneity of Immunotherapy Response and Immune-Related Toxicities by Longitudinal ctDNA and Immune Cell Compartment Tracking in Lung Cancer

Joseph C. Murray, Lavanya Sivapalan, Karlijn Hummelink, Archana Balan, James R. White, Noushin Niknafs, Lamia Rhymee, Gavin Pereira, Nisha Rao, Benny Weksler, Nathan Bahary, Jillian Phallen, Alessandro Leal, David L. Bartlett, Kristen A. Marrone, Jarushka Naidoo, Akul Goel, Benjamin Levy, Samuel Rosner, Christine L. HannSusan C. Scott, Josephine Feliciano, Vincent K. Lam, David S. Ettinger, Qing Kay Li, Peter B. Illei, Kim Monkhorst, Robert B. Scharpf, Julie R. Brahmer, Victor Velculescu, Ali H. Zaidi, Patrick M. Forde, Valsamo Anagnostou

Research output: Contribution to journalArticlepeer-review


Purpose: Although immunotherapy is the mainstay of therapy for advanced non–small cell lung cancer (NSCLC), robust biomarkers of clinical response are lacking. The heterogeneity of clinical responses together with the limited value of radiographic response assessments to timely and accurately predict therapeutic effect—especially in the setting of stable disease—calls for the development of molecularly informed real-time minimally invasive approaches. In addition to capturing tumor regression, liquid biopsies may be informative in capturing immune-related adverse events (irAE). Experimental Design: We investigated longitudinal changes in circulating tumor DNA (ctDNA) in patients with metastatic NSCLC who received immunotherapy-based regimens. Using ctDNA targeted error-correction sequencing together with matched sequencing of white blood cells and tumor tissue, we tracked serial changes in cell-free tumor load (cfTL) and determined molecular response. Peripheral T-cell repertoire dynamics were serially assessed and evaluated together with plasma protein expression profiles. Results: Molecular response, defined as complete clearance of cfTL, was significantly associated with progression-free (log-rank P ¼ 0.0003) and overall survival (log-rank P ¼ 0.01) and was particularly informative in capturing differential survival outcomes among patients with radiographically stable disease. For patients who developed irAEs, on-treatment peripheral blood T-cell repertoire reshaping, assessed by significant T-cell receptor (TCR) clonotypic expansions and regressions, was identified on average 5 months prior to clinical diagnosis of an irAE. Conclusions: Molecular responses assist with the interpretation of heterogeneous clinical responses, especially for patients with stable disease. Our complementary assessment of the peripheral tumor and immune compartments provides an approach for monitoring of clinical benefits and irAEs during immunotherapy.

Original languageEnglish (US)
Pages (from-to)389-403
Number of pages15
JournalClinical Cancer Research
Issue number2
StatePublished - Jan 15 2024

ASJC Scopus subject areas

  • General Medicine


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