Nodal immune flare mimics nodal disease progression following neoadjuvant immune checkpoint inhibitors in non-small cell lung cancer

Tina Cascone (), Annikka Weissferdt, Myrna C. B. Godoy, William N. William, Cheuk H. Leung, Heather Y. Lin, Sreyashi Basu, Shalini S. Yadav, Apar Pataer, Kyle G. Mitchell, Md Abdul Wadud Khan, Yushu Shi, Cara Haymaker, Luisa M. Solis, Edwin R. Parra, Humam Kadara, Ignacio I. Wistuba, Padmanee Sharma, James P. Allison, Nadim J. Ajami, Jennifer A. Wargo, Robert R. Jenq, Don L. Gibbons, J. Jack Lee, Stephen G. Swisher, Ara A. Vaporciyan, John V. Heymach () and Boris Sepesi
Additional contact information
Tina Cascone: The University of Texas MD Anderson Cancer Center
Annikka Weissferdt: The University of Texas MD Anderson Cancer Center
Myrna C. B. Godoy: The University of Texas MD Anderson Cancer Center
William N. William: The University of Texas MD Anderson Cancer Center
Cheuk H. Leung: The University of Texas MD Anderson Cancer Center
Heather Y. Lin: The University of Texas MD Anderson Cancer Center
Sreyashi Basu: The University of Texas MD Anderson Cancer Center
Shalini S. Yadav: The University of Texas MD Anderson Cancer Center
Apar Pataer: The University of Texas MD Anderson Cancer Center
Kyle G. Mitchell: The University of Texas MD Anderson Cancer Center
Md Abdul Wadud Khan: The University of Texas MD Anderson Cancer Center
Yushu Shi: The University of Texas MD Anderson Cancer Center
Cara Haymaker: The University of Texas MD Anderson Cancer Center
Luisa M. Solis: The University of Texas MD Anderson Cancer Center
Edwin R. Parra: The University of Texas MD Anderson Cancer Center
Humam Kadara: The University of Texas MD Anderson Cancer Center
Ignacio I. Wistuba: The University of Texas MD Anderson Cancer Center
Padmanee Sharma: The University of Texas MD Anderson Cancer Center
James P. Allison: The University of Texas MD Anderson Cancer Center
Nadim J. Ajami: The University of Texas MD Anderson Cancer Center
Jennifer A. Wargo: The University of Texas MD Anderson Cancer Center
Robert R. Jenq: The University of Texas MD Anderson Cancer Center
Don L. Gibbons: The University of Texas MD Anderson Cancer Center
J. Jack Lee: The University of Texas MD Anderson Cancer Center
Stephen G. Swisher: The University of Texas MD Anderson Cancer Center
Ara A. Vaporciyan: The University of Texas MD Anderson Cancer Center
John V. Heymach: The University of Texas MD Anderson Cancer Center
Boris Sepesi: The University of Texas MD Anderson Cancer Center

Nature Communications, 2021, vol. 12, issue 1, 1-15

Abstract: Abstract Radiographic imaging is the standard approach for evaluating the disease involvement of lymph nodes in patients with operable NSCLC although the impact of neoadjuvant immune checkpoint inhibitors (ICIs) on lymph nodes has not yet been characterized. Herein, we present an ad hoc analysis of the NEOSTAR trial (NCT03158129) where we observed a phenomenon we refer to as “nodal immune flare” (NIF) in which patients treated with neoadjuvant ICIs demonstrate radiologically abnormal nodes post-therapy that upon pathological evaluation are devoid of cancer and demonstrate de novo non-caseating granulomas. Abnormal lymph nodes are analyzed by computed tomography and 18F-fluorodeoxyglucose positron emission tomography/computer tomography to evaluate the size and the maximum standard uptake value post- and pre-therapy in NEOSTAR and an independent neoadjuvant chemotherapy cohort. NIF occurs in 16% (7/44) of patients treated with ICIs but in 0% (0/28) of patients after neoadjuvant chemotherapy. NIF is associated with an inflamed nodal immune microenvironment and with fecal abundance of genera belonging to the family Coriobacteriaceae of phylum Actinobacteria, but not with tumor responses or treatment-related toxicity. Our findings suggest that this apparent radiological cancer progression in lymph nodes may occur due to an inflammatory response after neoadjuvant immunotherapy, and such cases should be evaluated by pathological examination to distinguish NIF from true nodal progression and to ensure appropriate clinical treatment planning.

Date: 2021
References: Add references at CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
https://www.nature.com/articles/s41467-021-25188-0 Abstract (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:nat:natcom:v:12:y:2021:i:1:d:10.1038_s41467-021-25188-0

Ordering information: This journal article can be ordered from
https://www.nature.com/ncomms/

DOI: 10.1038/s41467-021-25188-0

Access Statistics for this article

Nature Communications is currently edited by Nathalie Le Bot, Enda Bergin and Fiona Gillespie

More articles in Nature Communications from Nature
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().