Predominance of Central Memory T Cells with High T-Cell Receptor Repertoire Diversity is Associated with Response to PD-1/PD-L1 Inhibition in Merkel Cell Carcinoma

Ivelina Spassova, Selma Ugurel, Patrick Terheyden, Antje Sucker, Jessica C. Hassel, Cathrin Ritter, Linda Kubat, Daniel Habermann, Farnoush Farahpour, Mohammadkarim Saeedghalati, Lukas Peiffer, Lukas Peiffer, Rajiv Kumar, Rajiv Kumar, David Schrama, David Schrama, Daniel Hoffmann, Dirk Schadendorf, Jurgen C. Becker, Jurgen C. BeckerJurgen C. Becker

3 Citations (Scopus)


Purpose: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer, which can be effectively controlled by immunotherapy with PD-1/PD-L1 checkpoint inhibitors. However, a significant proportion of patients are characterized by primary therapy resistance. Predictive biomarkers for response to immunotherapy are lacking. Experimental Design: We applied Bayesian inference analyses on 41 patients with MCC testing various clinical and biomolecular characteristics to predict treatment response. Further, we performed a comprehensive analysis of tumor tissue-based immunologic parameters including multiplexed immunofluorescence for T-cell activation and differentiation markers, expression of immune-related genes and T-cell receptor (TCR) repertoire analyses in 18 patients, seven objective responders, and 11 nonresponders. Results: Bayesian inference analyses demonstrated that among currently discussed biomarkers only unimpaired overall performance status and absence of immunosuppression were associated with response to therapy. However, in responders, a predominance of central memory T cells and expression of genes associated with lymphocyte attraction and activation was evident. In addition, TCR repertoire usage of tumor-infiltrating lymphocytes (TILs) demonstrated low T-cell clonality, but high TCR diversity in responding patients. In nonresponders, terminally differentiated effector T cells with a constrained TCR repertoire prevailed. Sequential analyses of tumor tissue obtained during immunotherapy revealed a more pronounced and diverse clonal expansion of TILs in responders indicating an impaired proliferative capacity among TILs of nonresponders upon checkpoint blockade. Conclusions: Our explorative study identified new tumor tissue-based molecular characteristics associated with response to anti-PD-1/PD-L1 therapy inMCC. These observationswarrant further investigations in larger patient cohorts to confirm their potential value as predictive markers.

Original languageEnglish
JournalClinical Cancer Research
Issue number9
Pages (from-to)2257-2267
Number of pages11
Publication statusPublished - 01.05.2020

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)


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