Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth most common cancer in the United States. Even with the recent approval of immune modulating therapies, the overall survival rate for patients that respond poorly to conventional therapy remains at 40-50%, depending on subsite. We anticipate that significant improvements to patient survival will require the development of precision medicine protocols, in which treatments are designed to target the specific disease process of the individual patient. Immune checkpoint inhibition represents one potential targeted strategy, and pembrolizumab, which inhibits the interaction of the Programmed Death-1 (PD-1) receptor with its ligands, was approved for treatment of metastatic and recurrent HNSCC in 2016. However, an objective response rate of only 18% was reported in phase II trials of pembrolizumab, and few biomarkers reliably predict responses. We believe a more detailed understanding of the mechanisms underlying expression of the immunosuppressive Programmed Death Ligand 1 (PD-L1), will aid in patient selection for anti-PD-1 therapy and provide new avenues to improve response rates and duration. Our preliminary data suggest that the fibroblast growth factor receptor (FGFR) family may participate in PD-L1 regulation in specific subsets of HNSCC models, highlighting the potential for targetable oncogenic drivers to modulate this immunosuppressive pathway. Our central hypothesis is that genetic and immune biomarkers can predict immune checkpoint response in advanced or recurrent HNSCC, some of which (e.g. FGFR1) serve as molecular targets to alter the immunogenicity of tumor cells. Thus, this proposal has two aims that extend our initial observation of a relationship between the FGFR family and PD-L1 to define a mechanism and investigate combination FGFR and PD-1/PD-L1 inhibition as a potential therapeutic strategy. To expand this concept further, we have generated HNSCC cell lines infected with the Genome CRISPR Knock-Out (GeCKO) library from which we will first aim to select genetic knockouts conferring alterations in PD-L1 presentation on the cell surface, thereby implicating pathways involved in PD- L1 regulation. Using in vitro and in vivo models, we then aim to assess the mechanistic role of these pathways in modulating PD-L1 to identify novel therapeutic targets that may contribute to immunosuppression. By defining pathways regulating the PD-1/PD-L1 immune checkpoint, this proposal has the immediate potential to help improve upon current immunotherapy protocols for HNSCC to improve overall patient survival.

Public Health Relevance

Head and Neck Squamous Cell Carcinoma (HNSCC) is an aggressive disease with limited treatment options to substantially extend overall survival, which remains at about 50%. Our proposal aims to expand upon current immunotherapeutic and other targeted strategies and understand biomarkers that may inform patient care decisions. We expect that our research will identify and advance novel targets modulating immunosuppressive pathways and develop personalized combination protocols to improve upon the efficacy of presently available treatments for HNSCC.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
1F31DE027600-01
Application #
9470457
Study Section
NIDR Special Grants Review Committee (DSR)
Program Officer
Frieden, Leslie A
Project Start
2017-09-01
Project End
2020-08-31
Budget Start
2017-09-01
Budget End
2018-08-31
Support Year
1
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Otolaryngology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
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Smith, Joshua; Kulkarni, Aditi; Birkeland, Andrew C et al. (2018) Whole-Exome Sequencing of Sinonasal Small Cell Carcinoma Arising within a Papillary Schneiderian Carcinoma In Situ. Otolaryngol Head Neck Surg 159:859-865
Hoesli, Rebecca; Birkeland, Andrew C; Rosko, Andrew J et al. (2018) Proportion of CD4 and CD8 tumor infiltrating lymphocytes predicts survival in persistent/recurrent laryngeal squamous cell carcinoma. Oral Oncol 77:83-89