Fecal microbiota transplant overcomes resistance to anti-PD-1 therapy in melanoma patients
Diwakar Davar, Amiran K Dzutsev, John A McCulloch, Richard R Rodrigues, Joe-Marc Chauvin, Robert M Morrison, Richelle N Deblasio, Carmine Menna, Quanquan Ding, Ornella Pagliano, Bochra Zidi, Shuowen Zhang, Jonathan H Badger, Marie Vetizou, Alicia M Cole, Miriam R Fernandes, Stephanie Prescott, Raquel G F Costa, Ascharya K Balaji, Andrey Morgun, Ivan Vujkovic-Cvijin, Hong Wang, Amir A Borhani, Marc B Schwartz, Howard M Dubner, Scarlett J Ernst, Amy Rose, Yana G Najjar, Yasmine Belkaid, John M Kirkwood, Giorgio Trinchieri, Hassane M Zarour, Diwakar Davar, Amiran K Dzutsev, John A McCulloch, Richard R Rodrigues, Joe-Marc Chauvin, Robert M Morrison, Richelle N Deblasio, Carmine Menna, Quanquan Ding, Ornella Pagliano, Bochra Zidi, Shuowen Zhang, Jonathan H Badger, Marie Vetizou, Alicia M Cole, Miriam R Fernandes, Stephanie Prescott, Raquel G F Costa, Ascharya K Balaji, Andrey Morgun, Ivan Vujkovic-Cvijin, Hong Wang, Amir A Borhani, Marc B Schwartz, Howard M Dubner, Scarlett J Ernst, Amy Rose, Yana G Najjar, Yasmine Belkaid, John M Kirkwood, Giorgio Trinchieri, Hassane M Zarour
Abstract
Anti-programmed cell death protein 1 (PD-1) therapy provides long-term clinical benefits to patients with advanced melanoma. The composition of the gut microbiota correlates with anti-PD-1 efficacy in preclinical models and cancer patients. To investigate whether resistance to anti-PD-1 can be overcome by changing the gut microbiota, this clinical trial evaluated the safety and efficacy of responder-derived fecal microbiota transplantation (FMT) together with anti-PD-1 in patients with PD-1-refractory melanoma. This combination was well tolerated, provided clinical benefit in 6 of 15 patients, and induced rapid and durable microbiota perturbation. Responders exhibited increased abundance of taxa that were previously shown to be associated with response to anti-PD-1, increased CD8+ T cell activation, and decreased frequency of interleukin-8-expressing myeloid cells. Responders had distinct proteomic and metabolomic signatures, and transkingdom network analyses confirmed that the gut microbiome regulated these changes. Collectively, our findings show that FMT and anti-PD-1 changed the gut microbiome and reprogrammed the tumor microenvironment to overcome resistance to anti-PD-1 in a subset of PD-1 advanced melanoma.
Trial registration: ClinicalTrials.gov NCT03341143.
Conflict of interest statement
Competing interests: D.D. reports the following disclosures: Merck, Bristol-Myers Squibb, Checkmate Pharmaceuticals, CellSight Technologies, MedPacto, and GlaxoSmithKline (research support); Array Biopharma, Checkmate Pharmaceuticals, Incyte, Immunocore, and Merck; Shionogi (consulting); and Vedanta Biosciences (scientific advisory board). Y.G.N. reports the following disclosures: Merck, Pfizer, and Bristol-Myers Squibb (research support). J.M.K. reports the following disclosures: Amgen, Bristol-Myers Squibb, Castle Biosciences, Checkmate Pharmaceuticals, Immunocore LLC, Iovance, and Novartis (research support) and Amgen, Bristol-Myers Squibb, Checkmate Pharmaceuticals, and Novartis (consulting). H.M.Z. reports the following disclosures: Bristol-Myers Squibb, Checkmate Pharmaceuticals, and GlaxoSmithKline (research support) and Bristol-Myers Squibb, Checkmate Pharmaceuticals, GlaxoSmithKline, and Vedanta (consulting). The other authors declare no competing interests.
Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
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References
- Larkin J et al., JAMA Oncol. 1, 433–440 (2015).
- Ribas A et al., JAMA 315, 1600–1609 (2016).
- Robert C et al., N. Engl. J. Med 372, 320–330 (2015).
- Robert C et al., Lancet Oncol. 20, 1239–1251 (2019).
- Robert C et al., N. Engl. J. Med 372, 2521–2532 (2015).
- Dzutsev A, Goldszmid RS, Viaud S, Zitvogel L, Trinchieri G, Eur. J. Immunol 45, 17–31 (2015).
- Finlay BB et al., Nat. Rev. Immunol 20, 522–528 (2020).
- Goldszmid RS et al., Cancer Immunol. Res 3, 103–109 (2015).
- Zarour HM, Clin. Cancer Res 22, 1856–1864 (2016).
- Gopalakrishnan V et al., Science 359, 97–103 (2018).
- Matson V et al., Science 359, 104–108 (2018).
- Routy B et al., Science 359, 91–97 (2018).
- Frankel AE et al., Neoplasia 19, 848–855 (2017).
- Peters BA et al., Genome Med. 11, 61 (2019).
- Eisenhauer EA et al., Eur. J. Cancer 45, 228–247 (2009).
- Kluger HM et al., J. Immunother. Cancer 8, e000398 (2020).
- Ribas A, Kirkwood JM, Flaherty KT, Lancet Oncol. 19, e219 (2018).
- Zeng MY et al., Immunity 44, 647–658 (2016).
- Pinato DJ et al., JAMA Oncol. 5, 1774–1778 (2019).
- Krieg C et al., Nat. Med 24, 144–153 (2018).
- Nowicka M et al., F1000Res. 6, 748 (2017).
- Pittet MJ, Speiser DE, Valmori D, Cerottini JC, Romero P, J. Immunol 164, 1148–1152 (2000).
- Ohkawa T et al., Immunology 103, 281–290 (2001).
- Guia S et al., Blood 111, 5008–5016 (2008).
- Hasumi K, Aoki Y, Wantanabe R, Mann DL, OncoImmunology 2, e26381 (2013).
- Ribas A et al., Cancer Immunol. Res 4, 194–203 (2016).
- Kamphorst AO et al., Proc. Natl. Acad. Sci. U.S.A 114, 4993–4998 (2017).
- Kunert A et al., J. Immunother. Cancer 7, 149 (2019).
- Stuart T et al., Cell 177, 1888–1902.e21 (2019).
- Schalper KA et al., Nat. Med 26, 688–692 (2020).
- Alshetaiwi H et al., Sci. Immunol 5, eaay6017 (2020).
- Gok Yavuz B et al., Sci. Rep 9, 3172 (2019).
- Terme M et al., Cancer Res. 71, 5393–5399 (2011).
- Benci JL et al., Cell 167, 1540–1554.e12 (2016).
- Danilo M, Chennupati V, Silva JG, Siegert S, Held W, Cell Rep. 22, 2107–2117 (2018).
- Koblish HK, Hunter CA, Wysocka M, Trinchieri G, Lee WM, J. Exp. Med 188, 1603–1610 (1998).
- Sanmamed MF et al., Ann. Oncol 28, 1988–1995 (2017).
- Vernocchi P, Del Chierico F, Putignani L, Front. Microbiol 7, 1144 (2016).
- Pallister T et al., Sci. Rep 7, 13670 (2017).
- Martinez-Guryn K et al., Cell Host Microbe 23, 458–469.e5 (2018).
- Rodrigues RR, Shulzhenko N, Morgun A, Methods Mol. Biol 1849, 227–242 (2018).
- Yambartsev A et al., Biol. Direct 11, 52 (2016).
- Shannon P et al., Genome Res. 13, 2498–2504 (2003).
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