Patients with ASPSCR1-TFE3 fusion achieve better response to ICI based combination therapy among TFE3-rearranged renal cell carcinoma

• Published in: Molecular cancer 2024-06, Vol.23 (1), p.132-8, Article 132
• Main Authors: Zhao, Junjie, Tang, Yanfeng, Hu, Xu, Yin, Xiaoxue, Chen, Yuntian, Chen, Junru, Liu, Haoyang, Liu, Haolin, Liang, Jiayu, Zhang, Xingming, Zhao, Jinge, Zhu, Sha, Ni, Yuchao, Wang, Zhipeng, Dai, Jindong, Wang, Zilin, Zhang, Yaowen, Yao, Jin, Chen, Ni, Shen, Pengfei, Liu, Zhenhua H, Zeng, Hao, Sun, Guangxi X
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antimitotic agents; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; ASPSCR1; Basic Helix-Loop-Helix Leucine Zipper Transcription Factors - genetics; Biomarkers, Tumor - genetics; Carcinoma, Renal cell; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - genetics; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Care and treatment; Collagen; Combination therapy; Correspondence; Female; Fusion partner; Gene Rearrangement; Health aspects; Humans; Immune checkpoint inhibitor; Immune Checkpoint Inhibitors - therapeutic use; Intracellular Signaling Peptides and Proteins - genetics; Kidney Neoplasms - drug therapy; Kidney Neoplasms - genetics; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Male; Metastasis; Middle Aged; Molecular correlates; Oncogene Proteins, Fusion - genetics; Prognosis; RNA; RNA sequencing; TFE3-rRCC; Treatment Outcome; Tyrosine
• ISSN: 1476-4598; 1476-4598
• DOI: 10.1186/s12943-024-02044-5

TFE3-rearranged renal cell carcinoma (TFE3-rRCC) is a rare but highly heterogeneous renal cell carcinoma (RCC) entity, of which the clinical treatment landscape is largely undefined. This study aims to evaluate and compare the efficacy of different systemic treatments and further explore the molecular correlates. Thirty-eight patients with metastatic TFE3-rRCC were enrolled. Main outcomes included progression-free survival (PFS), overall survival, objective response rate (ORR) and disease control rate. RNA sequencing was performed on 32 tumors. Patients receiving first-line immune checkpoint inhibitor (ICI) based combination therapy achieved longer PFS than those treated without ICI (median PFS: 11.5 vs. 5.1 months, P = 0.098). After stratification of fusion partners, the superior efficacy of first-line ICI based combination therapy was predominantly observed in ASPSCR1-TFE3 rRCC (median PFS: not reached vs. 6.5 months, P = 0.01; ORR: 67.5% vs. 10.0%, P = 0.019), but almost not in non-ASPSCR1-TFE3 rRCC. Transcriptomic data revealed enrichment of ECM and collagen-related signaling in ASPSCR1-TFE3 rRCC, which might interfere with the potential efficacy of anti-angiogenic monotherapy. Whereas angiogenesis and immune activities were exclusively enriched in ASPSCR1-TFE3 rRCC and promised the better clinical outcomes with ICI plus tyrosine kinase inhibitor combination therapy. The current study represents the largest cohort comparing treatment outcomes and investigating molecular correlates of metastatic TFE3-rRCC based on fusion partner stratification. ICI based combination therapy could serve as an effective first-line treatment option for metastatic ASPSCR1-TFE3 rRCC patients. Regarding with other fusion subtypes, further investigations should be performed to explore the molecular mechanisms to propose pointed therapeutic strategy accordingly.