Document Type : Review Article

Author

Jarallh German specialized clinic laboratory,Kuwait, Kuwait Kuwait German Urology Unit(KGUU)

Abstract

The ability of immunotherapy to treat ovarian cancer is currently limited, however evaluating sensitive/resistant target treatment subpopulations based on stratification by tumor biomarkers may enhance this ability. These indicators include the number of tumor mutations, PD-L1, tumor-infiltrating lymphocytes, a lack of homologous recombination, and intratumoral heterogeneity of neoantigens. The use of these indicators to choose the best candidates for ovarian cancer treatment is one of the future directions. In addition to reviewing innovative treatments and study designs including tumor biomarkers that improve the chances of immunotherapy success in ovarian cancer, this paper also analyzes the function of immunotherapy in ovarian cancer.

Keywords

1.Torre, Lindsey A et al. “Ovarian cancer statistics,
2018.” CA: a cancer journal for clinicians vol. 68,4 (2018):
284-296.
2.Siegel, Rebecca L., Kimberly 1.Torre, Lindsey A et al. “Ovarian cancer statistics, 2018.” CA: a cancer journal for clinicians vol. 68,4 (2018): 284-296.
2.Siegel, Rebecca L., Kimberly D. Miller, and Ahmedin Jemal. “Cancer statistics, 2019.” CA: a cancer journal for clinicians 69.1 (2019): 7-34.
3.Howlader, Nadia, et al. “Differences in breast cancer survival by molecular subtypes in the United States.” Cancer Epidemiology, Biomarkers & Prevention 27.6 (2018): 619-626.
4.Winarto, Hariyono, et al. “Overall Survival and Related Factors of Advanced-stage Epithelial Ovarian Cancer Patients Underwent Debulking Surgery in Jakarta, Indonesia: A Single-center Experience.” Open Access Macedonian Journal of Medical Sciences 10.B (2022): 265-280.
5.Perez-Fidalgo, J. Alejandro, et al. “Systemic treatment of newly diagnosed advanced epithelial ovarian cancer: From chemotherapy to precision medicine.” Critical Reviews in Oncology/Hematology 158 (2021): 103209.
6.Morand, Susan, et al. “Ovarian cancer immunotherapy and personalized medicine.” International Journal of Molecular Sciences 22.12 (2021): 6532.
7.González-Martín, Antonio, et al. “Niraparib in patients with newly diagnosed advanced ovarian cancer.” New England Journal of Medicine 381.25 (2019): 2391-2402.‏
8.Salmaninejad, Arash, et al. “PD‐1/PD‐L1 pathway: Basic biology and role in cancer immunotherapy.” Journal of cellular physiology 234.10 (2019): 16824-16837.‏
9.Tumeh, Paul C., et al. “PD-1 blockade induces responses by inhibiting adaptive immune resistance.” Nature 515.7528 (2014): 568-571.
10.Granier, Clemence, et al. “Mechanisms of action and rationale for the use of checkpoint inhibitors in cancer.” ESMO open 2.2 (2017): e000213.
11.Keenan, Tanya E., Kelly P. Burke, and Eliezer M. Van Allen. “Genomic correlates of response to immune checkpoint blockade.” Nature medicine 25.3 (2019): 389-402.
12.Conway, Jake R., et al. “Genomics of response to immune checkpoint therapies for cancer: implications for precision medicine.” Genome medicine 10.1 (2018): 1-18.‏
13.Pellegrino, Benedetta, et al. “Homologous recombination repair deficiency and the immune response in breast cancer: a literature review.” Translational oncology 13.2 (2020): 410-422.
14.Paijens, Sterre T., et al. “Tumor-infiltrating lymphocytes in the immunotherapy era.” Cellular & molecular immunology 18.4 (2021): 842-859.‏
15.Meléndez, Bárbara, et al. “Methods of measurement for tumor mutational burden in tumor tissue.” Translational lung cancer research 7.6 (2018): 661.
16.Choucair, Khalil, et al. “TMB: a promising immune-response biomarker, and potential spearhead in advancing targeted therapy trials.” Cancer gene therapy 27.12 (2020): 841-853.
17.Yarchoan, Mark, Alexander Hopkins, and Elizabeth M. Jaffee. “Tumor mutational burden and response rate to PD-1 inhibition.” New England Journal of Medicine 377.25 (2017): 2500-2501.
18.Yarchoan, Mark, et al. “PD-L1 expression and tumor mutational burden are independent biomarkers in most cancers.” JCI insight 4.6 (2019).
19.Hellmann, Matthew D., et al. “Tumor mutational burden and efficacy of nivolumab monotherapy and in combination with ipilimumab in small-cell lung cancer.” Cancer cell 33.5 (2018): 853-861.
20.Chan, Timothy A., et al. “Development of tumor mutation burden as an immunotherapy biomarker: utility for the oncology clinic.” Annals of Oncology 30.1 (2019): 44-56.‏
21.McGranahan, Nicholas, et al. “Clonal neoantigens elicit T cell immunoreactivity and sensitivity to immune checkpoint blockade.” Science 351.6280 (2016): 1463-1469.
22.Benvenuto, Monica, et al. “Tumor antigens heterogeneity and immune response-targeting neoantigens in breast cancer.” Seminars in Cancer Biology. Vol. 72. Academic Press, 2021.
23.Alsaab, Hashem O., et al. “PD-1 and PD-L1 checkpoint signaling inhibition for cancer immunotherapy: mechanism, combinations, and clinical outcome.” Frontiers in pharmacology 8 (2017): 561.
24.Ansell, Stephen M., et al. “PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma.” New England Journal of Medicine 372.4 (2015): 311-319.‏
25.Keung, Man Yee T., Yanyuan Wu, and Jaydutt V. Vadgama. “PARP inhibitors as a therapeutic agent for homologous recombination deficiency in breast cancers.” Journal of clinical medicine 8.4 (2019): 435.
26.Moschetta, M., et al. “BRCA somatic mutations and epigenetic BRCA modifications in serous ovarian cancer.” Annals of Oncology 27.8 (2016): 1449-1455.‏
27.Elvin, Julia Andrea, et al. “Comprehensive genomic profiling (CGP) with loss of heterozygosity (LOH) to identify therapeutically relevant subsets of ovarian cancer (OC).” (2017): 5512-5512.
28.da Cunha Colombo Bonadio, Renata Rodrigues, et al. “Homologous recombination deficiency in ovarian cancer: a review of its epidemiology and management.” Clinics 73 (2018).
29.Konstantinopoulos, Panagiotis A., et al. “Homologous recombination deficiency: exploiting the fundamental vulnerability of ovarian cancer.” Cancer discovery 5.11 (2015): 1137-1154.
30.Frey, Melissa K., and Bhavana Pothuri. “Homologous recombination deficiency (HRD) testing in ovarian cancer clinical practice: a review of the literature.” Gynecologic oncology research and practice 4.1 (2017): 1-11.
31.Manchana, Tarinee, Natacha Phoolcharoen, and Patou Tantbirojn. “BRCA mutation in high grade epithelial ovarian cancers.” Gynecologic oncology reports 29 (2019): 102-105.
32.Cortellini, Alessio, et al. “Family history of cancer as surrogate predictor for immunotherapy with anti-PD1/PD-L1 agents: preliminary report of the FAMI-L1 study.” Immunotherapy 10.8 (2018): 643-655.
33.Dunphy, Gillian, et al. “Non-canonical activation of the DNA sensing adaptor STING by ATM and IFI16 mediates NF-κB signaling after nuclear DNA damage.” Molecular cell 71.5 (2018): 745-760.
34.Plesca, Ioana, et al. “Characteristics of tumor-infiltrating lymphocytes prior to and during immune checkpoint inhibitor therapy.” Frontiers in Immunology 11 (2020): 364.
35.Mosier, Jenna A., et al. “Cancer cell metabolic plasticity in migration and metastasis.” Clinical & Experimental Metastasis 38.4 (2021): 343-359.
36.Clarke, Blaise, et al. “Intraepithelial T cells and prognosis in ovarian carcinoma: novel associations with stage, tumor type, and BRCA1 loss.” Modern Pathology 22.3 (2009): 393-402.
37.Hwang, Wei-Ting, et al. “Prognostic significance of tumor-infiltrating T cells in ovarian cancer: a meta-analysis.” Gynecologic oncology 124.2 (2012): 192-198.‏
38.Westergaard, Marie Christine Wulff, et al. “Tumour-reactive T cell subsets in the microenvironment of ovarian cancer.” British journal of cancer 120.4 (2019): 424-434.‏
39.Frey, Melissa K., and Bhavana Pothuri. “Homologous recombination deficiency (HRD) testing in ovarian cancer clinical practice: a review of the literature.” Gynecologic oncology research and practice 4.1 (2017): 1-11.
40.Barber, Emma, and Daniela Matei. “Immunotherapy in ovarian cancer: we are not there yet.” The Lancet Oncology 22.7 (2021): 903-905.
41.Ledermann, Jonathan A., et al. “Avelumab in combination with and/or following chemotherapy vs chemotherapy alone in patients with previously untreated epithelial ovarian cancer: results from the phase 3 javelin ovarian 100 trial.” SGO 2020 Annual Meeting on Women’s Cancer. SGO, 2020.
42.Moore, Kathleen N., and Sandro Pignata. “Trials in progress: IMagyn050/GOG 3015/ENGOT-OV39. A Phase III, multicenter, randomized study of atezolizumab versus placebo administered in combination with paclitaxel, carboplatin, and bevacizumab to patients with newly-diagnosed stage III or stage IV ovarian, fallopian tube, or primary peritoneal cancer.” International journal of gynecologic cancer 29.2 (2019).
43.Marabelle, Aurelien, et al. “Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair–deficient cancer: Results from the phase II KEYNOTE-158 study.” Journal of Clinical Oncology 38.1 (2020): 1.
44.Matulonis, U. A., et al. “Antitumor activity and safety of pembrolizumab in patients with advanced recurrent ovarian cancer: results from the phase II KEYNOTE-100 study.” Annals of Oncology 30.7 (2019): 1080-1087.
45.Sabbatini, Paul, et al. “Abagovomab as maintenance therapy in patients with epithelial ovarian cancer: a phase III trial of the AGO OVAR, COGI, GINECO, and GEICO—the MIMOSA study.” Journal of clinical oncology 31.12 (2013): 1554.
46.Zhang, Wen, et al. “Phase I/II clinical trial of a Wilms’ tumor 1-targeted dendritic cell vaccination-based immunotherapy in patients with advanced cancer.” Cancer Immunology, Immunotherapy 68.1 (2019): 121-130.
47.Sarivalasis, Apostolos, et al. “A Phase I/II trial comparing autologous dendritic cell vaccine pulsed either with personalized peptides (PEP-DC) or with tumor lysate (OC-DC) in patients with advanced high-grade ovarian serous carcinoma.” Journal of translational medicine 17.1 (2019): 1-10.
48.Han, Yun et al. “Wilms’ tumor 1 (WT1) promotes ovarian cancer progression by regulating E-cadherin and ERK1/2 signaling.” Cell cycle (Georgetown, Tex.) vol. 19,20 (2020): 2662-2675.
49.Salvatorelli, Lucia, et al. “Wilms tumor 1 (WT1) protein: Diagnostic utility in pediatric tumors.” Acta histochemica 117.4-5 (2015): 367-378.
50.Thomas, Sunil, and George C. Prendergast. “Cancer vaccines: a brief overview.” Vaccine Design (2016): 755-761.
51.Kverneland, Anders Handrup, et al. “Adoptive cell therapy in combination with checkpoint inhibitors in ovarian cancer.” Oncotarget 11.22 (2020): 2092.
52.Rocconi, Rodney Paul, et al. “A phase I combination study of vigil and atezolizumab in recurrent/refractory advanced-stage ovarian cancer: Efficacy assessment in BRCA1/2-wt patients.” (2020): 3002-3002.
53.Wang, Peipei et al. “Beyond Tumor Mutation Burden: Tumor Neoantigen Burden as a Biomarker for Immunotherapy and Other Types of Therapy.” Frontiers in oncology vol. 11 672677. 29 Apr. 2021,
54.Tanyi, Janos L., et al. “Personalized cancer vaccine effectively mobilizes antitumor T cell immunity in ovarian cancer.” Science translational medicine 10.436 (2018): eaao5931.
55.Morand, Susan, et al. “BRCA1/2 mutation status impact on autophagy and immune response: Unheralded target.” JNCI Cancer Spectrum 4.6 (2020): pkaa077.‏
56.Jeda, Ali Salimi, et al. “Autophagy Modulation and Cancer Combination Therapy: A Smart Approach in Cancer Therapy.” Cancer Treatment and Research Communications (2022): 100512.
D. Miller, and Ahmedin
Jemal. “Cancer statistics, 2019.” CA: a cancer journal for
clinicians 69.1 (2019): 7-34.
3.Howlader, Nadia, et al. “Differences in breast cancer survival
by molecular subtypes in the United States.” Cancer
Epidemiology, Biomarkers & Prevention 27.6 (2018):
619-626.
4.Winarto, Hariyono, et al. “Overall Survival and Related
Factors of Advanced-stage Epithelial Ovarian Cancer
Patients Underwent Debulking Surgery in Jakarta,
Indonesia: A Single-center Experience.” Open Access
Macedonian Journal of Medical Sciences 10.B (2022):
265-280.
5.Perez-Fidalgo, J. Alejandro, et al. “Systemic treatment of
newly diagnosed advanced epithelial ovarian cancer: From
chemotherapy to precision medicine.” Critical Reviews in
Oncology/Hematology 158 (2021): 103209.
6.Morand, Susan, et al. “Ovarian cancer immunotherapy and
personalized medicine.” International Journal of Molecular
Sciences 22.12 (2021): 6532.
7.González-Martín, Antonio, et al. “Niraparib in patients
with newly diagnosed advanced ovarian cancer.” New
England Journal of Medicine 381.25 (2019): 2391-2402.
8.Salmaninejad, Arash, et al. “PD‐1/PD‐L1 pathway: Basic
biology and role in cancer immunotherapy.” Journal of
cellular physiology 234.10 (2019): 16824-16837.
9.Tumeh, Paul C., et al. “PD-1 blockade induces responses by
inhibiting adaptive immune resistance.” Nature 515.7528
(2014): 568-571.
10.Granier, Clemence, et al. “Mechanisms of action
and rationale for the use of checkpoint inhibitors in
cancer.” ESMO open 2.2 (2017): e000213.
11.Keenan, Tanya E., Kelly P. Burke, and Eliezer M. Van
Allen. “Genomic correlates of response to immune
checkpoint blockade.” Nature medicine 25.3 (2019):
389-402.
12.Conway, Jake R., et al. “Genomics of response to immune
checkpoint therapies for cancer: implications for precision
medicine.” Genome medicine 10.1 (2018): 1-18.
13.Pellegrino, Benedetta, et al. “Homologous recombination
repair deficiency and the immune response in breast
cancer: a literature review.” Translational oncology 13.2
(2020): 410-422.
14.Paijens, Sterre T., et al. “Tumor-infiltrating lymphocytes
in the immunotherapy era.” Cellular & molecular
immunology 18.4 (2021): 842-859.
15.Meléndez, Bárbara, et al. “Methods of measurement for
tumor mutational burden in tumor tissue.” Translational
lung cancer research 7.6 (2018): 661.
16.Choucair, Khalil, et al. “TMB: a promising immune-
response biomarker, and potential spearhead in advancing
targeted therapy trials.” Cancer gene therapy 27.12 (2020):
841-853.
17.Yarchoan, Mark, Alexander Hopkins, and Elizabeth M.
Jaffee. “Tumor mutational burden and response rate to PD-1
inhibition.” New England Journal of Medicine 377.25
(2017): 2500-2501.
18.Yarchoan, Mark, et al. “PD-L1 expression and tumor
mutational burden are independent biomarkers in most
cancers.” JCI insight 4.6 (2019).
19.Hellmann, Matthew D., et al. “Tumor mutational burden
and efficacy of nivolumab monotherapy and in combination
with ipilimumab in small-cell lung cancer.” Cancer
cell 33.5 (2018): 853-861.
20.Chan, Timothy A., et al. “Development of tumor mutation
burden as an immunotherapy biomarker: utility for the
oncology clinic.” Annals of Oncology 30.1 (2019): 44-56.
21.McGranahan, Nicholas, et al. “Clonal neoantigens
elicit T cell immunoreactivity and sensitivity to immune
checkpoint blockade.” Science 351.6280 (2016): 1463-
1469.
22.Benvenuto, Monica, et al. “Tumor antigens heterogeneity
and immune response-targeting neoantigens in breast
cancer.” Seminars in Cancer Biology. Vol. 72. Academic
Press, 2021.
23.Alsaab, Hashem O., et al. “PD-1 and PD-L1 checkpoint
signaling inhibition for cancer immunotherapy: mechanism,
combinations, and clinical outcome.” Frontiers in
pharmacology 8 (2017): 561.
24.Ansell, Stephen M., et al. “PD-1 blockade with nivolumab
in relapsed or refractory Hodgkin’s lymphoma.” New
England Journal of Medicine 372.4 (2015): 311-319.
25.Keung, Man Yee T., Yanyuan Wu, and Jaydutt V. Vadgama.
“PARP inhibitors as a therapeutic agent for homologous
recombination deficiency in breast cancers.” Journal of
clinical medicine 8.4 (2019): 435.
26.Moschetta, M., et al. “BRCA somatic mutations and
epigenetic BRCA modifications in serous ovarian
cancer.” Annals of Oncology 27.8 (2016): 1449-1455.
27.Elvin, Julia Andrea, et al. “Comprehensive genomic
profiling (CGP) with loss of heterozygosity (LOH) to
identify therapeutically relevant subsets of ovarian cancer
(OC).” (2017): 5512-5512.
28.da Cunha Colombo Bonadio, Renata Rodrigues, et al.
“Homologous recombination deficiency in ovarian cancer:
a review of its epidemiology and management.” Clinics 73
(2018).
29.Konstantinopoulos, Panagiotis A., et al. “Homologous
recombination deficiency: exploiting the fundamental
vulnerability of ovarian cancer.” Cancer discovery 5.11
(2015): 1137-1154.
30.Frey, Melissa K., and Bhavana Pothuri. “Homologous
recombination deficiency (HRD) testing in ovarian cancer
clinical practice: a review of the literature.” Gynecologic
oncology research and practice 4.1 (2017): 1-11.
31.Manchana, Tarinee, Natacha Phoolcharoen, and Patou
Tantbirojn. “BRCA mutation in high grade epithelial
ovarian cancers.” Gynecologic oncology reports 29
(2019): 102-105.
32.Cortellini, Alessio, et al. “Family history of cancer as
surrogate predictor for immunotherapy with anti-PD1/
PD-L1 agents: preliminary report of the FAMI-L1
study.” Immunotherapy 10.8 (2018): 643-655.
33.Dunphy, Gillian, et al. “Non-canonical activation of the
DNA sensing adaptor STING by ATM and IFI16 mediates
NF-κB signaling after nuclear DNA damage.” Molecular
cell 71.5 (2018): 745-760.
34.Plesca, Ioana, et al. “Characteristics of tumor-infiltrating
lymphocytes prior to and during immune checkpoint
inhibitor therapy.” Frontiers in Immunology 11 (2020): 364.
35.Mosier, Jenna A., et al. “Cancer cell metabolic plasticity
in migration and metastasis.” Clinical & Experimental
Metastasis 38.4 (2021): 343-359.
36.Clarke, Blaise, et al. “Intraepithelial T cells and prognosis
in ovarian carcinoma: novel associations with stage, tumor
type, and BRCA1 loss.” Modern Pathology 22.3 (2009):
393-402.
37.Hwang, Wei-Ting, et al. “Prognostic significance of
tumor-infiltrating T cells in ovarian cancer: a meta-
analysis.” Gynecologic oncology 124.2 (2012): 192-198.
38.Westergaard, Marie Christine Wulff, et al. “Tumour-
reactive T cell subsets in the microenvironment of ovarian
cancer.” British journal of cancer 120.4 (2019): 424-434.
39.Frey, Melissa K., and Bhavana Pothuri. “Homologous
recombination deficiency (HRD) testing in ovarian cancer
clinical practice: a review of the literature.” Gynecologic
oncology research and practice 4.1 (2017): 1-11.
40.Barber, Emma, and Daniela Matei. “Immunotherapy
in ovarian cancer: we are not there yet.” The Lancet
Oncology 22.7 (2021): 903-905.
41.Ledermann, Jonathan A., et al. “Avelumab in combination
with and/or following chemotherapy vs chemotherapy
alone in patients with previously untreated epithelial
ovarian cancer: results from the phase 3 javelin ovarian
100 trial.” SGO 2020 Annual Meeting on Women’s
Cancer. SGO, 2020.
42.Moore, Kathleen N., and Sandro Pignata. “Trials in
progress: IMagyn050/GOG 3015/ENGOT-OV39. A Phase
III, multicenter, randomized study of atezolizumab versus
placebo administered in combination with paclitaxel,
carboplatin, and bevacizumab to patients with newly-
diagnosed stage III or stage IV ovarian, fallopian tube,
or primary peritoneal cancer.” International journal of
gynecologic cancer 29.2 (2019).
43.Marabelle, Aurelien, et al. “Efficacy of pembrolizumab in
patients with noncolorectal high microsatellite instability/
mismatch repair–deficient cancer: Results from the phase II
KEYNOTE-158 study.” Journal of Clinical Oncology 38.1
(2020): 1.
44.Matulonis, U. A., et al. “Antitumor activity and safety
of pembrolizumab in patients with advanced recurrent
ovarian cancer: results from the phase II KEYNOTE-100
study.” Annals of Oncology 30.7 (2019): 1080-1087.
45.Sabbatini, Paul, et al. “Abagovomab as maintenance
therapy in patients with epithelial ovarian cancer: a
phase III trial of the AGO OVAR, COGI, GINECO,
and GEICO—the MIMOSA study.” Journal of clinical
oncology 31.12 (2013): 1554.
46.Zhang, Wen, et al. “Phase I/II clinical trial of a Wilms’
tumor 1-targeted dendritic cell vaccination-based
immunotherapy in patients with advanced cancer.” Cancer
Immunology, Immunotherapy 68.1 (2019): 121-130.
47.Sarivalasis, Apostolos, et al. “A Phase I/II trial comparing
autologous dendritic cell vaccine pulsed either with
personalized peptides (PEP-DC) or with tumor lysate (OC-
DC) in patients with advanced high-grade ovarian serous
carcinoma.” Journal of translational medicine 17.1 (2019):
1-10.
48.Han, Yun et al. “Wilms’ tumor 1 (WT1) promotes ovarian
cancer progression by regulating E-cadherin and ERK1/2
signaling.” Cell cycle (Georgetown, Tex.) vol. 19,20
(2020): 2662-2675.
49.Salvatorelli, Lucia, et al. “Wilms tumor 1 (WT1)
protein: Diagnostic utility in pediatric tumors.” Acta
histochemica 117.4-5 (2015): 367-378.
50.Thomas, Sunil, and George C. Prendergast. “Cancer
vaccines: a brief overview.” Vaccine Design (2016):
755-761.
51.Kverneland, Anders Handrup, et al. “Adoptive cell
therapy in combination with checkpoint inhibitors in
ovarian cancer.” Oncotarget 11.22 (2020): 2092.
52.Rocconi, Rodney Paul, et al. “A phase I combination
study of vigil and atezolizumab in recurrent/refractory
advanced-stage ovarian cancer: Efficacy assessment in
BRCA1/2-wt patients.” (2020): 3002-3002.
53.Wang, Peipei et al. “Beyond Tumor Mutation Burden:
Tumor Neoantigen Burden as a Biomarker for
Immunotherapy and Other Types of Therapy.” Frontiers in
oncology vol. 11 672677. 29 Apr. 2021,
54.Tanyi, Janos L., et al. “Personalized cancer vaccine
effectively mobilizes antitumor T cell immunity in ovarian
cancer.” Science translational medicine 10.436 (2018):
eaao5931.
55.Morand, Susan, et al. “BRCA1/2 mutation status
impact on autophagy and immune response: Unheralded
target.” JNCI Cancer Spectrum 4.6 (2020): pkaa077.
56.Jeda, Ali Salimi, et al. “Autophagy Modulation and
Cancer Combination Therapy: A Smart Approach in
Cancer Therapy.” Cancer Treatment and Research
Communications (2022): 100512.