Skip to main content

() promoter hypomethylation predicts immunotherapy response in metastatic urothelial carcinoma.


Authors: Niklas Klümper, Lennert Wüst, Jonas Saal, Damian J Ralser, Romina Zarbl, Jonas Jarczyk, Johannes Breyer, Danijel Sikic, Bernd Wullich, Christian Bolenz, Florian Roghmann, Michael Hölzel, Manuel Ritter, Sebastian Strieth, Arndt Hartmann, Philipp Erben, Ralph M Wirtz, Jennifer Landsberg, Dimo Dietrich, Markus Eckstein

PD-L1 status assessed by immunohistochemistry (IHC) has failed to reliably predict outcomes for patients with metastatic urothelial carcinoma (mUC) on immune checkpoint blockade (ICB). promoter methylation is an epigenetic mechanism that has been shown to regulate mRNA expression in various malignancies. The aim of our present study was to evaluate the predictive potential of promoter methylation status () in ICB-treated mUC compared to conventional IHC-based PD-L1 assessment. We quantified in formalin-fixed and paraffin-embedded tissue sections using an established quantitative methylation-specific PCR assay (qMSP) in a well-characterized multicenter ICB-treated cohort comprising  = 107 patients with mUC. Additionally, PD-L1 protein expression in tumor tissues was assessed using regulatory approved IHC protocols. The effect of pharmacological hypomethylation by the DNA methyltransferase inhibitor decitabine in combination with interferon-γ stimulation in urothelial carcinoma cell lines was investigated by IHC and FACS. hypomethylation predicted objective response rate at the first staging on ICB. Patients with tumors categorized as hypomethylated (lower quartile) showed significantly prolonged progression-free (PFS) and overall survival (OS) after ICB initiation. In contrast, PD-L1 protein expression status neither correlated with response nor survival. In multivariable Cox regression analyses, promoter hypermethylation remained an independent predictor of unfavorable PFS and OS. In urothelial carcinoma cell lines, pharmacological demethylation led to an upregulation of membranous PD-L1 expression and an enhanced inducibility of PD-L1 expression by interferon γ. Hypomethylation of the promoter is a promising predictive biomarker for response to ICB in patients with mUC.

© 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

PMID: 37868689

Participating cluster members