Abstract
Simple SummaryThere is an increasing scientific interest in the study of the interaction between the immune system and drugs in cancer that can affect the efficacy of an anti-cancer treatment. This study was undertaken to better understand if the genetic characteristic of a cancer patient’s immune system can predict the tumor response to the treatment and the duration of survival. The topic was studied on 335 metastatic colorectal cancer patients treated with a first-line chemotherapy (FOLFIRI regimen, irinotecan-5-fluorouracil-leucovorin). The research highlighted two markers, IL15RA-rs7910212 and SMAD3-rs7179840, significantly associated with the patient’s survival. When considering IL15RA-rs7910212 and SMAD3-rs7179840 in combination with other two genetic markers previously investigated (NR1I2-rs1054190, VDR-rs7299460), we built up a highly predictive genetic score of survival. The herein identified markers must be further validated, but still represent good candidates to understand how much a patient with a metastatic colorectal cancer can benefit from a chemotherapy with FOLFIRI regimen.A new paradigm in cancer chemotherapy derives from the interaction between chemotherapeutics, including irinotecan and 5-fluorouracil (5-FU), and the immune system. The patient’s immune response can modulate chemotherapy effectiveness, and, on the other hand, chemotherapeutic agents can foster tumor cell immunogenicity. On these grounds, the analysis of the cancer patients’ immunogenetic characteristics and their effect on survival after chemotherapy represent a new frontier. This study aims to identify genetic determinants in the immuno-related pathways predictive of overall survival (OS) after FOLFIRI (irinotecan, 5-FU, leucovorin) therapy. Two independent cohorts comprising a total of 335 patients with metastatic colorectal cancer (mCRC) homogeneously treated with first-line FOLFIRI were included in the study. The prognostic effect of 192 tagging genetic polymorphisms in 34 immune-related genes was evaluated using the bead array technology. The IL15RA rs7910212-C allele was associated with worse OS in both discovery (HR: 1.57, p = 0.0327, Bootstrap p-value = 0.0280) and replication (HR: 1.71, p = 0.0411) cohorts. Conversely, SMAD3 rs7179840-C allele was associated with better OS in both discovery (HR: 0.65, p = 0.0202, Bootstrap p-value = 0.0203) and replication (HR: 0.61, p = 0.0216) cohorts. A genetic prognostic score was generated integrating IL15RA-rs7910212 and SMAD3-rs7179840 markers with inflammation-related prognostic polymorphisms we previously identified in the same study population (i.e., PXR [NR1I2]-rs1054190, VDR-rs7299460). The calculated genetic score successfully discriminated patients with different survival probabilities (p < 0.0001 log-rank test). These findings provide new insight on the prognostic value of genetic determinants, such as IL15RA and SMAD3 markers, and could offer a new decision tool to improve the clinical management of patients with mCRC receiving FOLFIRI.
Highlights
The cooperation between chemotherapeutic agents and immune system aiming at eradicating tumors represents a new paradigm in cancer chemotherapy
The secondary endpoint was to integrate these genetic markers related to the immune system with those related to the inflammation response (i.e., NR1I2-rs1054190, vitamin D receptor (VDR)-rs7299460), that we previously identified in the same study population [12], to generate a genetic score of overall survival (OS) that could further improve the clinical management of patients with metastatic colorectal cancer (CRC) (mCRC)
The present study identified novel genetic prognostic markers, the IL15RA-rs7910212 and SMAD3-rs7179840 polymorphisms, which resulted in being significantly associated with OS in mCRC patients treated with the first-line FOLFIRI regimen
Summary
The cooperation between chemotherapeutic agents and immune system aiming at eradicating tumors represents a new paradigm in cancer chemotherapy. Irinotecan and 5-fluorouracil (5-FU) have a significant immune-modulatory effect, influencing the overall antitumor response and disease outcome [3,4,5,6,7]. These findings open up a novel field of immunogenetic investigation aimed at defining the role of the host variability in immune-related genes in predicting the response to treatment and patients’ prognosis. We have previously reported significant associations between genetic variants in inflammation-related transcriptional regulators and clinical outcome after administration of FOLFIRI (irinotecan, 5-FU, leucovorin) [11,12,13]. Pregnane X receptor (PXR; NR1I2) rs1054190 and vitamin D receptor (VDR) rs7299460 polymorphisms emerged as prognostic markers of OS for metastatic CRC (mCRC) patients receiving FOLFIRI [12]
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