Influence of Tumor Mutational Burden, Inflammatory Gene Expression Profile, and PD-L1 Expression on Response to Pembrolizumab in Head and Neck Squamous Cell Carcinoma

Background: To characterize genomic determinants of response to pembrolizumab in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) in the KEYNOTE-012 study.

Methods: Associations between biomarkers (tumor mutational burden (TMB), neoantigen load (NL), 18-gene T-cell-inflamed gene expression profile (TcellGEP), and PD-L1 combined positive score (CPS)) and clinical outcomes with pembrolizumab were assessed in patients with R/M HNSCC (n=192). Tumor human papillomavirus (HPV) status was also evaluated with the use of p16 immunohistochemistry and whole exome sequencing (WES; HPV, mapping >20 HPV reads) in pretreatment tumor samples (n=106).

Results: TMB, clonality-weighted TMB, and TcellGEP were significantly associated with objective response (p0.0276, p0.0201, and p0.006, respectively), and a positive trend was observed between NL and PD-L1 CPS and clinical response (p0.0550 and p0.0682, respectively). No correlation was observed between TMB and TcellGEP (Spearman ρ=-0.026) or TMB and PD-L1 (Spearman ρ=0.009); a correlation was observed between TcellGEP and PD-L1 (Spearman ρ=0.511). HPV status by WES and p16 immunohistochemistry showed concordance (84% ҡ=0.573) among patients whose HPV results were available using both methods.

Conclusions: TMB and inflammatory biomarkers (TcellGEP and PD-L1) may represent distinct and complementary biomarkers predicting response to anti-programmed death 1 therapies in HNSCC; further study of these relationships in randomized clinical trials is needed.

Trial Registration Number: NCT01848834.