Down-regulated HHLA2 enhances neoadjuvant immunotherapy efficacy in patients with non-small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD)

• Published in: BMC cancer 2024-03, Vol.24 (1), p.396-396, Article 396
• Main Authors: Zeng, Ao, Yin, Yanze, Xu, Zhilong, Abuduwayiti, Abudumijiti, Yang, Fujun, Shaik, Mohammed Saud, Wang, Chao, Chen, Keyi, Fang, Xinyun, Dai, Jie
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; Carcinoma, Non-Small-Cell Lung - drug therapy; CD103 antigen; CD8 antigen; Cell death; China; Chronic obstructive pulmonary disease; Flow cytometry; Gene expression; Genes; HERV–H LTR-associating protein 2; Humans; Immune checkpoint; Immunoglobulins; Immunohistochemistry; Immunological memory; Immunotherapy; Lung cancer; Lung diseases; Lung Neoplasms - genetics; Lymphocytes; Lymphocytes T; Medical prognosis; Memory cells; Neoadjuvant immunotherapy; Neoadjuvant Therapy; Non-small cell lung cancer; Non-small cell lung carcinoma; Patients; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - therapy; Regression analysis; Small cell lung carcinoma; Software; T cell receptors; Tissue-resident memory T cells
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-12137-5

Emerging data suggested a favorable outcome in advanced non-small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD) patients treated by immunotherapy. The objective of this study was to investigate the effectiveness of neoadjuvant immunotherapy among NSCLC with COPD versus NSCLC without COPD and explore the potential mechanistic links. Patients with NSCLC receiving neoadjuvant immunotherapy and surgery at Shanghai Pulmonary Hospital between November 2020 and January 2023 were reviewed. The assessment of neoadjuvant immunotherapy's effectiveness was conducted based on the major pathologic response (MPR). The gene expression profile was investigated by RNA sequencing data. Immune cell proportions were examined using flow cytometry. The association between gene expression, immune cells, and pathologic response was validated by immunohistochemistry and single-cell data. A total of 230 NSCLC patients who received neoadjuvant immunotherapy were analyzed, including 60 (26.1%) with COPD. Multivariate logistic regression demonstrated that COPD was a predictor for MPR after neoadjuvant immunotherapy [odds ratio (OR), 2.490; 95% confidence interval (CI), 1.295-4.912; P = 0.007]. NSCLC with COPD showed a down-regulation of HERV-H LTR-associating protein 2 (HHLA2), which was an immune checkpoint molecule, and the HHLA2 group demonstrated the enrichment of CD8 CD103 tissue-resident memory T cells (TRM) compared to the HHLA2 group (11.9% vs. 4.2%, P = 0.013). Single-cell analysis revealed TRM enrichment in the MPR group. Similarly, NSCLC with COPD exhibited a higher proportion of CD8 CD103 TRM compared to NSCLC without COPD (11.9% vs. 4.6%, P = 0.040). The study identified NSCLC with COPD as a favorable lung cancer type for neoadjuvant immunotherapy, offering a new perspective on the multimodality treatment of this patient population. Down-regulated HHLA2 in NSCLC with COPD might improve the MPR rate to neoadjuvant immunotherapy owing to the enrichment of CD8 CD103 TRM. Approval for the collection and utilization of clinical samples was granted by the Ethics Committee of Shanghai Pulmonary Hospital (Approval number: K23-228).