MHC class I loss in endometrial carcinoma: a potential resistance mechanism to immune checkpoint inhibition

Mod Pathol. 2021 Mar;34(3):627-636. doi: 10.1038/s41379-020-00682-w. Epub 2020 Oct 3.

Abstract

Major histocompatibility complex (MHC) class I is a membrane-bound protein complex expressed on nucleated human cells. MHC class I presents intracellular protein fragments to cytotoxic T cells and triggers an activation cascade upon neoantigen detection by these cells. MHC class I loss by tumor cells decreases tumor neoantigen presentation to the immune system and therefore represents a possible mechanism of immunotherapeutic resistance even among cancers that otherwise appear to be good candidates for checkpoint inhibition, such as mismatch repair (MMR)-deficient and PD-L1-positive malignancies. We herein assess MHC class I expression in a range of endometrial carcinomas, including MMR-deficient and PD-L1-positive cancers. Immunohistochemical staining for combined MHC class I A-, B-, and C-heavy chains was performed on 76 cases of endometrial carcinoma and was classified as present, subclonally lost, or diffusely lost. Tumoral PD-L1 expression, PD-L1 combined positive score, and CD3-positive T lymphocytes were also quantified. Forty-two percent of tumors showed loss of MHC class I expression, either in a subclonal (26%) or diffuse (16%) pattern. This included 46% of MMR-deficient and 25% of PD-L1-positive cancers. These findings suggest that tumoral MHC class I status may be an important factor to consider when selecting endometrial cancer patients for checkpoint inhibition.

MeSH terms

  • B7-H1 Antigen / analysis
  • B7-H1 Antigen / antagonists & inhibitors*
  • Biomarkers, Tumor / analysis*
  • CD3 Complex / analysis
  • Carcinoma / drug therapy
  • Carcinoma / immunology*
  • Carcinoma / pathology
  • Clinical Decision-Making
  • DNA Mismatch Repair
  • Drug Resistance, Neoplasm*
  • Endometrial Neoplasms / drug therapy
  • Endometrial Neoplasms / immunology*
  • Endometrial Neoplasms / pathology
  • Female
  • Histocompatibility Antigens Class I / analysis*
  • Humans
  • Immune Checkpoint Inhibitors / therapeutic use*
  • Immunohistochemistry
  • Lymphocytes, Tumor-Infiltrating / immunology
  • Predictive Value of Tests
  • Tumor Microenvironment / immunology

Substances

  • B7-H1 Antigen
  • Biomarkers, Tumor
  • CD274 protein, human
  • CD3 Complex
  • Histocompatibility Antigens Class I
  • Immune Checkpoint Inhibitors