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This study investigated the combined effects of PD-1 blockade (pembrolizumab) and HER2-targeted therapy (trastuzumab) in a mouse model of HER2-positive gastric cancer, without chemotherapy. The combination therapy showed superior tumor growth control compared to either drug alone and was associated with increased cytotoxic immune activity alongside reduced epithelial-mesenchymal transition and extracellular matrix remodeling signatures. Notably, trastuzumab alone activated immune pathways but also increased tumor-promoting EMT signatures, while the addition of PD-1 blockade suppressed these potentially harmful effects.
Why it matters
These findings help clarify the biological mechanisms underlying the clinical success of combining immunotherapy with HER2-targeted therapy in gastric cancer patients, isolated from the confounding effects of chemotherapy. The identification of reduced stromal remodeling and EMT suppression as key features of combination therapy suggests potential biomarkers for treatment response and provides targets for further therapeutic development.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background The combination of PD-1 blockade, HER2-targeted therapy and chemotherapy improves outcomes in HER2-positive advanced gastric and gastro-oesophageal junction adenocarcinoma. However, chemotherapy can independently alter the tumour microenvironment, making the biological effects of PD-1 and HER2 targeting difficult to distinguish. We therefore investigated how PD-1 and HER2 blockade, alone and in combination, affect tumour growth and associated transcriptional programmes. Methods Immunodeficient NOG mice received human PBMCs by tail-vein injection. Three days later, NCI-N87 gastric cancer cells were implanted subcutaneously. Mice were randomised to vehicle, pembrolizumab, trastuzumab, or combination treatment. Tumour growth was assessed, and bulk RNA sequencing was used to identify treatment-associated changes in gene expression, pathway enrichment, and tumour, stromal, and immune cell-associated signatures. Results Combined treatment produced greater tumour growth control than either monotherapy. Trastuzumab-treated tumours showed enrichment of immune activation, epithelial-mesenchymal transition (EMT), and TGF{beta}-associated signatures, whereas pembrolizumab alone produced a limited transcriptional effect. Combination treatment was associated with reduced proliferation, EMT, and stromal-remodelling signatures, alongside increased cytotoxic immune-associated signatures. Expression of extracellular matrix-associated genes, including VCAN, SPARC, POSTN, collagen genes, and FAP, was lower in combination-treated tumours. Complement-related transcriptional pathways were also enriched. Conclusions In this chemotherapy-free model, combined PD-1 blockade and HER2-targeted therapy was associated with greater tumour growth control, enrichment of cytotoxic immune-associated transcriptional signatures, and reduced EMT and extracellular matrix remodelling signatures. These findings provide hypotheses for further mechanistic validation.