With the emergence of effective immunotherapeutics, which nevertheless harbor the potential for toxicity and are expensive to use, biomarkers are urgently needed for identification of cancer patients who respond to treatment. In this clinical-epidemiological study of 202 cancer patients treated with oncolytic adenoviruses, we address the biomarker value of serum high-mobility group box 1 (HMGB1) protein. Overall survival and imaging responses were studied as primary endpoints and adjusted for confounding factors in two multivariate analyses (Cox and logistic regression). Mechanistic studies included assessment of circulating tumor-specific T-cells by ELISPOT, virus replication by quantitative PCR, and inflammatory cytokines by cytometric bead array. Patients with low HMGB1 baseline levels (below median concentration) showed significantly improved survival (p = 0.008, Log-Rank test) and radiological disease control rate (49.2% vs. 30.0%, p = 0.038, χ2 test) as compared to high-baseline patients. In multivariate analyses, the low HMGB1 baseline status was a strong prognostic (HR 0.638, 95% CI 0.462-0.881) and the best predictive factor for disease control (OR 2.618, 95% CI 1.004-6.827). Indicative of an immune-mediated mechanism, antitumor T-cell activity in blood and response to immunogenic-transgene coding viruses associated with improved outcome only in HMGB1-low patients. Our results suggest that serum HMGB1 baseline is a useful prognostic and predictive biomarker for oncolytic immunotherapy with adenoviruses, setting the stage for prospective clinical studies.
Keywords: ATAP, Advanced Therapy Access Program; CD40L, CD40-ligand; CI, confidence interval; CT, contrast-enhanced computed tomography; DAMP, damage-associated molecular pattern; GMCSF, granulocyte-macrophage colony stimulating factor; HMGB1, high-mobility group box 1; HR, hazard ratio; IL-6, -8, -10, interleukin-6, -8, -10; ILT2, immunoglobulin-like transcript 2; MRI, magnetic resonance imaging; OR, odds ratio; PET, positron emission tomography; RECIST, Response Evaluation Criteria In Solid Tumors; TNF-a, tumor-necrosis factor-α; WHO, World Health Organization.; HMGB1; cancer; immunotherapy; oncolytic adenovirus; predictive markers; prognostic markers; tumor biomarkers.