3040 Background: Identifying responders to developing immune therapies is of high priority, yet identifying patients who will suffer from toxicity, which represents a unique spectrum of side effects, termed immune-related adverse events (irAEs), is critical. The complex host-specific response to immune therapies led us to hypothesize that germ-line mutations, present in both the tumor and in the host’s immune system, may be a source of biomarkers. As there is compelling evidence that recently discovered germ-line mutations disrupting microRNA (miRNA) networks act as biomarkers of treatment response and baseline immune status, we evaluated such mutations in patients treated with these therapies. Methods: Patients treated with anti-PD1 or anti-PDL1 therapy alone and clinically documented response and toxicity were tested with a panel of over 150 vetted germ-line miRNA based biomarkers. Of 85 patients evaluated for response, 75 had melanoma, and 10 had NSCLC. For analysis of toxicity, an additional 4 patients with other cancer types were included. Subjects were classified as responders (Complete, Partial) versus non-responders (Progressive, Stable), or as experiencing low irAEs (grade 0 and 1) versus high irAEs (grade 2 and above). We used Chi-squared analysis for base evaluation and then compared three classification techniques including classification trees, random forests and Bayesian probit regression with non-local priors. We estimated classification performance via leave-one-out cross validation. Results: By Chi-Squared analysis we found over a dozen biomarkers associated with response, and a dozen biomarkers associated with toxicity. These included germ-line mutations in 3’ untranslated regions as well as in miRNA promoter regions. We found that both classification trees and Bayesian probit compared reasonably well with random forests. We found a response signature with a specificity of 89% by Random Forests, and a toxicity signature with a specificity of 76% by Random Forests. Conclusions: We have shown that a new class of germ-line mutations disrupting miRNA regulatory networks can act as biomarkers of response and toxicity to anti-PD1 and anti-PDL1 therapy.
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