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© 2025 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Purpose

Anti-programmed cell death 1 (PD1) is the first-choice treatment in patients with advanced cutaneous squamous cell carcinoma (cSCC), when curative options are unavailable. However, reliable biomarkers for patient selection are still lacking.

Experimental design

In this translational study, clinical annotations, tissue and liquid biopsies were acquired to investigate the association between sustained objective responses and transcriptional profiles, immune cell dynamics in tumor tissue and peripheral blood samples, as well as circulating cytokine levels.

Results

First, we investigated the baseline characteristics of the immune landscape of cSCC biopsies. Gene Set Enrichment Analysis showed upregulation of interleukin (IL)2/STAT5 pathways and downregulation of Interferon signatures in non-responder patients compared with responders. Next, we studied the early changes induced by cemiplimab in tissue biopsies. Notably, after only three weeks, cemiplimab treatment induced an increase in B cells and CD8+ T cells in responders, whereas their abundance decreased in non-responder patients. Moreover, analyzing differentially expressed genes modulated early during treatment, compared with baseline biopsies, we found that IL1β and IL8 exhibited early downregulation in responder patients’ tumor specimens. We assessed whether changes in the local tumor microenvironment were mirrored in peripheral blood. Similar to tissue findings, no changes were observed in the whole T regulatory (Treg) population, although PD1+ Tregs, which were downregulated in responder patients (vs T0), showed a rebound enrichment in non-responders after three cycles of cemiplimab. Finally, IL8 mirrored the tissue results, unlike IL1β, with early (T1) and then sustained (T3) downregulation of its levels in responder patients, while increased in non-responders.

Conclusions

Taken together, these findings shed light on the significance of early transcriptomic and immune cell modulation in predicting responses to cemiplimab therapy. Additionally, our data suggest that IL8 levels in peripheral blood offer promising avenues for personalized treatment selection and response assessment in patients with cSCC receiving cemiplimab, while PD1+Tregs can be followed longitudinally to monitor response to therapy.

Details

Title
Early assessment of IL8 and PD1+ Treg predicts response and guides treatment monitoring in cemiplimab-treated cutaneous squamous cell carcinoma
Author
Esposito, Daniela 1   VIAFID ORCID Logo  ; Napolitano, Fabiana 1 ; Maresca, Daniela Claudia 2 ; Scala, Marcella 1 ; Amato, Annarita 1 ; Belli, Stefania 1 ; Ascione, Claudia Maria 1 ; Vallefuoco, Angela 1 ; Attanasio, Giovanna 1 ; Somma, Fabio 2 ; Ianaro, Angela 2 ; Russo, Daniela 3 ; Varricchio, Silvia 3 ; Mascolo, Massimo 3 ; Costa, Claudia 4 ; Villani, Alessia 4 ; Scalvenzi, Massimiliano 4 ; Orlandino, Gianfranco 5 ; Troiani, Teresa 6 ; Servetto, Alberto 1 ; Bianco, Roberto 1 ; Ercolano, Giuseppe 2 ; Formisano, Luigi 1 

 Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy 
 Department of Pharmacy, University of Naples Federico II, Naples, Italy 
 Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy 
 Section of Dermatology, Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy 
 Department of Plastic and Reconstructive Surgery, University of Naples Federico II, Naples, Italy 
 Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy 
First page
e010421
Section
Immunotherapy biomarkers
Publication year
2025
Publication date
Jan 2025
Publisher
BMJ Publishing Group LTD
e-ISSN
20511426
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3155371839
Copyright
© 2025 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.