Longitudinal analysis of PD-L1 expression in patients with relapsed NSCLC.

BACKGROUND: The use and approval of immune checkpoint inhibitors for the treatment of non-small cell lung cancer (NSCLC) depends on PD-L1 expression in the tumor tissue. Nevertheless, PD-L1 often fails to predict response to treatment. One possible explanation could be a change in PD-L1 expression during the course of the disease and the neglect of reassessment. The purpose of this study was a longitudinal analysis of PD-L1 expression in patients with relapsed NSCLC. METHODS: We retrospectively analyzed PD-L1 expression in patients with early-stage NSCLC and subsequent relapse in preoperative samples, matched surgical specimens and biopsy samples of disease recurrence. Ventana PD-L1 (SP263) immunohistochemistry assay was used for all samples. PD-L1 expression was scored based on clinically relevant groups (0%, 1%-49%, and ≥50%). The primary endpoint was the change in PD-L1 score group between preoperative samples, matched surgical specimens and relapsed tumor tissue. RESULTS: 395 consecutive patients with stages I-III NSCLC and 136 (34%) patients with a subsequent relapse were identified. For 87 patients at least two specimens for comparison of PD-L1 expression between early stage and relapsed disease were available. In 72 cases, a longitudinal analysis between preoperative biopsy, the surgically resected specimen and biopsy of disease recurrence was feasible. When comparing preoperative and matched surgical specimens, a treatment-relevant conversion of PD-L1 expression group was found in 25 patients (34.7%). Neoadjuvant treatment showed no significant effect on PD-L1 alteration (p=0.39). In 32 (36.8%) out of 87 cases, a change in PD-L1 group was observed when biopsies of disease relapse were compared with early-stage disease. Adjuvant treatment was not significantly associated with a change in PD-L1 expression (p=0.53). 39 patients (54.2%) showed at least 1 change into a different PD-L1 score group during the course of disease. 14 patients (19.4%) changed the PD-L1 score group twice, 5 (6.9%) of them being found in all different score groups. CONCLUSION: PD-L1 expression shows dynamic changes during the course of disease. There is an urgent need for consensus guidelines to define a PD-L1 testing strategy including time points of reassessment, the number of biopsies to be obtained and judgment of surgical specimens.

Soil moisture and temperature drive emergence delays associated with fire seasonality in eucalypt forests.

Many ecosystems are well adapted to fire, although the impacts of fire seasonality and its effect on post-fire recruitment are less well understood. Late summer or autumn fires within eucalypt forests with a Mediterranean-type climate allow for seedling emergence during the cooler and wetter seasons. The emergence and survival after spring fires may be impacted by higher soil temperatures and water stress, delaying recruitment until the subsequent winter period. During this delay, seeds may be exposed to predation and decay, which reduce the viable seed bank. This study examines post-fire recruitment dynamics in a eucalypt forest ecosystem (Northern Jarrah Forest (NJF) of southwestern Western Australia) and whether it may be vulnerable to human-induced changes to fire season. Here, we compare in situ post-fire seedling emergence patterns between autumn and spring burns and account for a potential ecological mechanism driving seasonal differences in emergence by determining the thermal germination requirements of seeds for 15 common species from the NJF. Our results demonstrate that 93% of species had thermal optima between 10°C and 20°C, analogous with soil temperatures measured during the germination window (late April to October). Concurrent in situ post-fire emergence was highest 144 days after an autumn (seasonal) fire, followed by a 10-72% decline. In contrast, there was no emergence within the first 200 days following a spring (aseasonal) fire. We conclude that aseasonal fire in the NJF can lead to a complete delay in recruitment in the first season post-fire, resulting in a lower inter-fire growth period and increasing the potential for further reductions in recruitment through seed predation and decay. The study suggests that aseasonal fire has an immediate and significant impact on initial recruitment in the NJF, but further research is required to determine any longer-term effects of this delay and its implications for fire management in southwestern Western Australia.

Early kinetics of C reactive protein for cancer-agnostic prediction of therapy response and mortality in patients treated with immune checkpoint inhibitors: a multicenter cohort study.

BACKGROUND: C reactive protein (CRP) kinetics have recently been suggested as predictive biomarkers for the efficacy of immune checkpoint inhibitor (ICI) therapy in selected cancer types. The aim of this study was to characterize early CRP kinetics as a tumor-agnostic biomarker for ICI treatment outcomes. METHODS: In this multicenter retrospective cohort study, two independent cohorts of patients with various cancer types undergoing palliative ICI treatment at Austrian academic centers served as the discovery (n=562) and validation cohort (n=474). Four different patterns of CRP kinetics in the first 3 months of ICI therapy were defined (CRP-flare responders, CRP-responders, CRP non-responders, patients with all-normal CRP). Objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were defined as coprimary endpoints. Univariable and multivariable logistic regression, landmark analysis and Cox regression including CRP kinetics as time-dependent variable were performed. RESULTS: The ORR in patients with all-normal CRP, CRP responders, CRP flare-responders and CRP non-responders was 41%, 38%, 31% and 12%, respectively. The median OS and PFS estimates were 24.5 months (95% CI 18.5 to not reached) and 8.2 months (95% CI 5.9 to 12.0) in patients with all-normal CRP, 16.1 months (95% CI 12.6 to 19-8) and 6.1 months (95% CI 4.9 to 7.2) in CRP-responders, 14.0 months (95% CI 8.5 to 19.4) and 5.7 months (95% CI 4.1 to 8.5) in CRP flare-responders and 8.1 months (95% CI 5.8 to 9.9) and 2.3 months (95% CI 2.2 to 2.8) in CRP non-responders (log-rank p for PFS and OS<0.001). These findings prevailed in multivariable analysis and could be fully confirmed in our validation cohort. Pooled subgroup analysis suggested a consistent predictive significance of early CRP kinetics for treatment efficacy and outcome independent of cancer type. CONCLUSION: Early CRP kinetics represent a tumor-agnostic predictor for treatment response, progression risk and mortality in patients with cancer undergoing ICI therapy.

Evidence of wet-dry cycles and mega-droughts in the Eemian climate of southeast Australia.

Understanding past climate variability is critical to informing debate of likely impacts of global warming on weather and climate, and water resources. Here we present a near annual resolution reconstruction of climate developed from a speleothem that spans the Eemian [Marine Isotope Stage 5e (MIS 5e)] from 117,500 to 123,500 years BP-the most recent period in the Earth's history when temperatures were similar to those of today. Using 25 Mg, 88Sr, and 137Ba as proxies, we show the first indication of solar and teleconnection cyclic forcing of Eemian climate in southeast Australia, a region at present often affected by severe drought and bushfires. We find evidence for multi-centennial dry periods interpreted as mega-droughts, and highlight the importance of understanding the causes of these in the context of a rapidly warming world, where temperatures are now, or projected to exceed those of the Eemian.

Global warming in the context of 2000 years of Australian alpine temperature and snow cover.

Annual resolution reconstructions of alpine temperatures are rare, particularly for the Southern Hemisphere, while no snow cover reconstructions exist. These records are essential to place in context the impact of anthropogenic global warming against historical major natural climate events such as the Roman Warm Period (RWP), Medieval Climate Anomaly (MCA) and Little Ice Age (LIA). Here we show for a marginal alpine region of Australia using a carbon isotope speleothem reconstruction, warming over the past five decades has experienced equivalent magnitude of temperature change and snow cover decline to the RWP and MCA. The current rate of warming is unmatched for the past 2000 years and seasonal snow cover is at a minimum. On scales of several decades, mean maximum temperatures have undergone considerable change ≈ ± 0.8 °C highlighting local scale susceptibility to rapid temperature change, evidence of which is often masked in regional to hemisphere scale temperature reconstructions.