The impact of the expression level of growth differentiation factor 15 in tumor tissue on the response to immunotherapy in non-small cell lung cancer

• Published in: BMC cancer Vol. 24; no. 1; pp. 954 - 9
• Main Authors: Akdogan, Orhun, Ogut, Betul, Sutcuoglu, Osman, Sert, Aysenur, Gurler, Fatih, Akyurek, Nalan, Ozdemir, Nuriye, Ozet, Ahmet, Yazici, Ozan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.08.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antibodies; Antineoplastic Agents, Immunological - therapeutic use; Biological markers; Biomarker; Biomarkers, Tumor - metabolism; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - immunology; Carcinoma, Non-Small-Cell Lung - metabolism; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Care and treatment; Cell activation; Cell differentiation; Chemotherapy; Development and progression; Diagnosis; Drug therapy; Female; GDF-15; Growth Differentiation Factor 15 - metabolism; Humans; Immunotherapy; Immunotherapy - methods; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Lung Neoplasms - drug therapy; Lung Neoplasms - immunology; Lung Neoplasms - metabolism; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Lymphocytes T; Male; Medical research; Medicine, Experimental; Metastases; Metastasis; Middle Aged; Mutation; Nivolumab - therapeutic use; Non-small cell lung carcinoma; NSCLC; Oncology; Patient outcomes; Patients; Pemetrexed; Prognosis; Progression-Free Survival; Proteins; Retrospective Studies; S phase; Small cell lung carcinoma; Survival analysis; T cells; Transforming growth factor-b; Transforming growth factors; Tumors; Viral antibodies; Turkey; United States > US; Biomarker; Chemotherapy; NSCLC; Immunotherapy; GDF-15
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-12727-3

Growth differentiation factor-15 (GDF-15), a member of the TGF-β superfamily, is overexpressed in various cancers and facilitates immune evasion by inhibiting T-cell activation. GDFATHER-TRIAL's phase 2a results demonstrated promising outcomes when combining the GDF-15 neutralizing antibody visugromab (CTL002) with nivolumab, enhancing the response to immunotherapy. This study evaluated the prognostic significance of GDF-15 expression in non-small cell lung cancer (NSCLC) tumor tissues in terms of immunotherapy response. This retrospective study included 50 patients with metastatic NSCLC treated with nivolumab at Gazi University Hospital between January 2021 and July 2023. GDF-15 expression was evaluated using immunochemistry staining and categorized based on the intensity of cytoplasmic or membranous staining. Samples were divided into a low expression group (scores 0 and 1) and a high expression group (scores 2 and 3). The primary outcomes were progression-free survival (PFS) and overall survival (OS), which were analyzed using Kaplan‒Meier and Cox proportional hazards models. Objective response rates were assessed in secondary outcomes. Of the 50 patients, 43 were men (86%), with a median age of 63.9 years. Half of the patients exhibited low GDF-15 expression. High GDF-15 expression correlated with shorter PFS and OS. The median PFS was 7.8 months for the low-expression group versus 4.4 months for the high-expression group (HR, 0.41; 95% CI, 0.20-0.83; p = 0.013). The median OS was 18.1 months for the low-expression group compared to 11.8 months for the high-expression group (HR, 0.36; 95% CI, 0.16-0.78; p = 0.007). The objective response rate was significantly greater in the low GDF-15 group (52%) than in the high GDF-15 group (24%) (p = 0.040). Elevated GDF-15 expression in NSCLC tumor tissues is associated with poorer response to nivolumab, suggesting that GDF-15 is a potential prognostic biomarker for immunotherapy efficacy. These findings warrant further validation through prospective studies to optimize treatment strategies for NSCLC patients.