# Peripheral Blood TCRβ Repertoire, IL15, IL2 and Soluble Ligands for NKG2D Activating Receptor Predict Efficacy of Immune Checkpoint Inhibitors in Lung Cancer

## TL;DR

This study explores biomarkers in lung cancer patients to predict how well they respond to immune checkpoint inhibitors, focusing on T cell diversity and cytokine levels.

## Contribution

The study identifies potential biomarkers like TCRβ diversity and IL-15 levels that may predict immunotherapy response in lung cancer patients.

## Key findings

- Higher TCRβ clonality and diversity were associated with better survival, though not statistically significant.
- Higher levels of IL-2 and IL-15 were linked to shorter survival times in patients receiving immunotherapy.
- High IL-15 levels tripled the risk of death in multivariable analysis.

## Abstract

The development of immune checkpoint inhibitors has revolutionized the treatment of lung cancer by becoming the standard therapy for advanced non-small cell lung cancer that lacks specific genetic mutations. However, not all patients respond equally, underscoring the need for biomarkers to predict treatment response. To address this, a study was conducted with 55 lung cancer patients treated with immune checkpoint inhibitors to investigate whether biomarkers like TCRβ diversity and certain cytokines linked to T cell activity could predict the response to immunotherapy. While higher TCRβ clonality and specific cytokine levels appeared to be associated with improved survival rates, the findings were not statistically significant. Specifically, higher levels of IL-2 and IL-15 were linked to shorter overall survival, with high IL-15 levels increasing the risk of death threefold in multivariable analysis. Although further research with larger sample sizes is needed for confirmation, these results offer promising insights into potential markers for predicting responses to immune checkpoint inhibitors.

The development of immune checkpoint inhibitors (ICIs) has changed the therapeutic paradigm of lung cancer (LC), becoming the standard of treatment for previously untreated advanced non-small cell lung cancer (NSCLC) without actionable mutations. It has allowed the achievement of durable responses and resulted in significant survival benefits. However, not all patients respond; hence, molecular biomarkers are needed to help us predict which patients will respond. With this objective, a prospective observational study was designed, including a cohort of 55 patients with NSCLC who received ICIs. We studied whether biomarkers such as TCRβ and specific cytokines involved in the regulation of T cell activity were related to the immunotherapy response. In the survival analysis, it was found that patients with higher TCRβ clonality, lower TCRβ evenness, higher TCRβ Shannon diversity and lower TCRβ convergence had higher overall survival (OS) and progression-free survival (PFS). However, no statistically significant association was observed. Regarding cytokines, those patients with higher levels of IL-2 and IL-15 presented statistically significantly shorter OS and PFS, respectively. In fact, in the multivariable analysis, the high IL-15 level increased the risk of death by three times. Although the sample size was small and more studies are needed to confirm our results, our study reveals promising markers of responses to ICIs.