Hyperprogression of cutaneous T cell lymphoma after anti-PD-1 treatment

Yumei Gao; Simeng Hu; Ruoyan Li; Shanzhao Jin; Fengjie Liu; Xiangjun Liu; Yingyi Li; Yicen Yan; Weiping Liu; Jifang Gong; Shuxia Yang; Ping Tu; Lin Shen; Fan Bai; Yang Wang

doi:10.1172/jci.insight.164793

Hyperprogression of cutaneous T cell lymphoma after anti-PD-1 treatment

Yumei Gao,¹ Simeng Hu,² Ruoyan Li,³ Shanzhao Jin,³ Fengjie Liu,¹ Xiangjun Liu,¹ Yingyi Li,¹ Yicen Yan,¹ Weiping Liu,⁴ Jifang Gong,⁵ Shuxia Yang,¹ Ping Tu,¹ Lin Shen,⁶ Fan Bai,³ and Yang Wang¹

Published January 17, 2023 - More info

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Abstract

BACKGROUND. Immune checkpoint blockade is an emerging treatment for T cell non-Hodgkin lymphoma (T-NHL), but some T-NHL patients have experienced hyperprogression with undetermined mechanisms upon anti-PD-1 therapy.

METHODS. Single-cell RNA sequencing, whole-genome sequencing, whole-exome sequencing, and functional assays were performed on primary malignant T cells from a patient with advanced cutaneous T cell lymphoma, who experienced hyperprogression upon anti-PD-1 treatment.

RESULTS. The patient was enrolled in a clinical trial of anti-PD-1 therapy and experienced disease hyperprogression. Single-cell RNA sequencing revealed that PD-1 blockade elicited a remarkable activation and proliferation of the CD4+ malignant T cells, which showed functional PD-1 expression and an exhausted status. Further analyses identified somatic amplification of PRKCQ in the malignant T cells. PRKCQ encodes PKCθ, a key player in the T cell activation/NF-kB pathway. PRKCQ amplification led to high expressions of PKCθ and p-PKCθ (T538) on the malignant T cells, resulting in an oncogenic activation of the T cell receptor (TCR) signaling pathway. PD-1 blockade in this patient released this signaling, de-repressed the proliferation of malignant T cells, and resulted in disease hyperprogression.

CONCLUSIONS. Our study provides real-world clinical evidence that PD-1 acts as a tumor suppressor for malignant T cells with oncogenic TCR activation.

TRIAL REGISTRATION. ClinicalTrials.gov (NCT03809767).

FUNDING. The National Natural Science Foundation of China (81922058), the National Science Fund for Distinguished Young Scholars (T2125002), the National Science and Technology Major Project (2019YFC1315702), the National Youth Top-Notch Talent Support Program (283812), and the Peking University Clinical Medicine plus X Youth Project (PKU2019LCXQ012).

Hyperprogression of cutaneous T cell lymphoma after anti-PD-1 treatment

Yumei Gao,¹ Simeng Hu,² Ruoyan Li,³ Shanzhao Jin,³ Fengjie Liu,¹ Xiangjun Liu,¹ Yingyi Li,¹ Yicen Yan,¹ Weiping Liu,⁴ Jifang Gong,⁵ Shuxia Yang,¹ Ping Tu,¹ Lin Shen,⁶ Fan Bai,³ and Yang Wang¹

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Hyperprogression of cutaneous T cell lymphoma after anti-PD-1 treatment

Yumei Gao,1 Simeng Hu,2 Ruoyan Li,3 Shanzhao Jin,3 Fengjie Liu,1 Xiangjun Liu,1 Yingyi Li,1 Yicen Yan,1 Weiping Liu,4 Jifang Gong,5 Shuxia Yang,1 Ping Tu,1 Lin Shen,6 Fan Bai,3 and Yang Wang1

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Yumei Gao,¹ Simeng Hu,² Ruoyan Li,³ Shanzhao Jin,³ Fengjie Liu,¹ Xiangjun Liu,¹ Yingyi Li,¹ Yicen Yan,¹ Weiping Liu,⁴ Jifang Gong,⁵ Shuxia Yang,¹ Ping Tu,¹ Lin Shen,⁶ Fan Bai,³ and Yang Wang¹