- McFaline-Figueroa, J;
- Sun, Lu;
- Youssef, Gilbert;
- Huang, Raymond;
- Li, Gang;
- Kim, Jiyoon;
- Lee, Eudocia;
- Nayak, Lakshmi;
- Chukwueke, Ugonma;
- Beroukhim, Rameen;
- Batchelor, Tracy;
- Chiocca, E;
- Everson, Richard;
- Doherty, Lisa;
- Stefanik, Jennifer;
- Partridge, Kathryn;
- Spearman, Amanda;
- Myers, Alexa;
- Westergaard, Catharina;
- Russ, Alyssa;
- Lavallee, Maria;
- Smokovich, Anna;
- LaForest-Roys, Corey;
- Garcia Fox, Rachel;
- McCluskey, Christine;
- Bi, Wenya;
- Arnaout, Omar;
- Peruzzi, PierPaolo;
- Cosgrove, G;
- Ligon, Keith;
- Arrillaga-Romany, Isabel;
- Clarke, Jennifer;
- Reardon, David;
- Cloughesy, Timothy;
- Prins, Robert;
- Wen, Patrick
Glioblastoma is immunologically cold and resistant to single-agent immune-checkpoint inhibitors (ICI). Our previous study of neoadjuvant pembrolizumab in surgically-accessible recurrent glioblastoma identified a molecular signature of response to ICI and suggested that neoadjuvant pembrolizumab may improve survival. To increase the power of this observation, we enrolled an additional 25 patients with a primary endpoint of evaluating the cell cycle gene signature associated with neoadjuvant pembrolizumab and performed bulk-RNA seq on resected tumor tissue (NCT02852655). Neoadjuvant pembrolizumab was associated with suppression of cell cycle/cancer proliferation genes and upregulation of T-cell/interferon-related gene expression. This signature was unique to patients treated with neoadjuvant pembrolizumab and was an independent positive risk factor for survival. Our results demonstrate a clear pharmacodynamic effect of anti-PD1 therapy in glioblastoma and identify pathways that may mediate resistance. However, we did not confirm a survival benefit to neoadjuvant pembrolizumab in recurrent glioblastoma and our secondary endpoint of PFS-6 was 19.5% (95% CI: 9.29-41.2%) for the pooled neoadjuvant cohorts. Our new data suggests some patients may exhibit innate resistance to pre-surgical ICI and require other concomitant therapies to sensitize effectively.