作者与单位 Authors & Affiliations
Kenichi Shimada1, Filipa Lynce2, Claudine Isaacs3, Xue Geng3, Edward T. Richardson4, Candace Mainor3, Mei Wei5, Julie M. Collins3, Paula R. Pohlmann6, Arielle L. Heeke7, Kelly F. Zheng4, Madeline Townsend4, Lauren M. Sloat1, Jane Staunton1, Stuart J. Schnitt4, Hongkun Wang3, Joan S. Brugge1, Geoffrey I. Shapiro2, Jennifer L. Guerriero4
1Harvard Medical School, Boston, MA,2Dana-Farber Cancer Institute, Boston, MA,3Georgetown University, Washington, DC,4Brigham and Women's Hospital, Boston, MA,5University of Utah, Salt Lake City, UT,6The University of Texas MD Anderson Cancer Center, Houston, TX,7Atrium Health, Charlotte, NC
摘要 Abstract
Background
PARP inhibitors (PARPi) induce synthetic lethality in BRCA1/2-mutant (BRCA-MUT) tumors and can activate DNA-damage-linked immune pathways. The TALAVE study (NCT03964532) examined the combination of the PARPi (talazoparib) with PD-L1 blockade (avelumab). Here we evaluated spatially resolved immune signaling and remodeling in response to talazoparib alone and with avelumab.
Methods
24 patients with advanced HER2-negative breast cancer (12 BRCA-MUT, 12 BRCA-WT) received talazoparib then talazoparib + avelumab. Serial biopsies (baseline, post-PARPi [BX2], post-combination [BX3]) underwent transcriptomic, spatial protein, and multiplex IF. BRCA-dependent TME remodeling and cellular neighborhood (CN) shifts were assessed.
Results
BRCA-MUT tumors showed 83% objective response and 100% clinical benefit, whereas BRCA-WT tumors exhibited minimal activity. BRCA-MUT tumors became fragmented with increased immune activity, while BRCA-WT tumors remained compact and immunosuppressed. gammaH2AX and pTBK1 were spatially co-expressed and sustained in BRCA-MUT tumors during treatment but declined in BRCA-WT tumors. BRCA-MUT tumors displayed enrichment of CD8 + T cells and CD163 + macrophages after PARPi, whereas CD4 + T cells and CD68 + CD163 + macrophages were depleted in BRCA-WT tumors. PD-1 + CD8⁺ T cells were strongly linked to local CD4⁺ T cell density, and PD-1 + frequency in CD8 + T cells correlated with longer PFS at baseline and BX3 in BRCA-MUT but not BRCA-WT tumors.
CN analysis revealed CD4 + and CD8 + enriched neighborhoods with intermediate PD-1 expression that expanded after therapy in BRCA-MUT but not BRCA-WT tumors, and these CNs lacked PD-L1⁺ cells. Between BX2 and BX3, BRCA-MUT tumors sustained immune activity but showed no further T cell activation or infiltration. Spatial mapping identified three PD-L1 + CN types: (1) T cell-dense niches with high PD-1/PD-L1 and gammaH2AX-pTBK1 activity enriched only at baseline, largely lost after PARPi; (2) macrophage-T cell mixtures that were depleted during therapy; and (3) PD-L1 + dying tumor cells lacking pTBK1 activity and T cell engagement. Across contexts, PD-L1 was either lost before PD-L1 blockade or confined to regions isolated from T cells, leaving little opportunity to reinvigorate T cells.
Conclusions
PARP inhibition reshaped the TME of BRCA-MUT tumors by inducing tumor fragmentation, sustaining gammaH2AX-pTBK1 signaling, and restoring CD4 + and CD163 + immune cells, whereas BRCA-WT tumors remained structurally intact and immunosuppressed. PD-1 + T cells localized to PD-L1-negative neighborhoods, and PD-L1 + tumor/myeloid cells were rapidly lost or confined to dying, immune-excluded regions, limiting the impact of PD-L1 blockade. Although PARPi re-engaged T cell programs in BRCA-MUT tumors, strategies beyond PD-L1 inhibition will be required to further enhance T cell infiltration and activation.
利益披露 Disclosure
K. Shimada,
FELIQS Corporation Stock Option.
F. Lynce, None..
C. Isaacs, None..
X. Geng, None..
E. T. Richardson, None..
C. Mainor, None..
M. Wei, None..
J. M. Collins, None..
P. R. Pohlmann, None..
A. L. Heeke, None..
K. F. Zheng, None..
M. Townsend, None..
L. M. Sloat, None..
S. J. Schnitt, None..
H. Wang, None.
G. I. Shapiro,
Merck KGaA / EMD-Serono ), Other.
Artios ).
Lilly ).
Pfizer ).
Circle Pharmaceuticals Other.
Concarlo Therapeutics Other.
Schrödinger Other.
FoRx Therapeutics Other.
MycRx Other.
J. L. Guerriero,
Antana Bio LLC Independent Contractor.
Array BioPharma/Pfizer Independent Contractor, ).
AstraZeneca Independent Contractor.
BD Biosciences Independent Contractor.
BigHat Independent Contractor.
Duke Street Bio Independent Contractor, ).
Genentech Independent Contractor.
GlaxoSmithKline Independent Contractor, ).
Incyte Independent Contractor.
iTeos Independent Contractor.
Laverock Independent Contractor.
LTZ Independent Contractor.
OncoOne Independent Contractor.
Synkine Independent Contractor.
Voro Independent Contractor.
Eli Lilly ).
Merck ).