Immune-checkpoint inhibitor (ICI) therapy, including antibodies targeting programmed cell death protein 1(PD-1), programmed death-ligand 1 (PD-L1), or cytotoxic T-lymphocyte–associated protein 4 (CTLA4), has demonstrated impressive clinical efficacy in controlling advanced cancers. Recent studies have identified several positive predictive markers for ICI, including high levels of microsatellite instability (MSI-high), PD-L1 overexpression, and elevated tumor mutation burden (TMB).
1 The genes that encode DNA polymerase epsilon (
POLE) and delta 1 (
POLD1) are essential for proofreading and fidelity in DNA replication.
2 Their germline or somatic mutations can lead to DNA-repair deficiencies and carcinogenesis via a DNA hypermutated molecular phenotype.
3,4 An association between
POLE or
POLD1 mutations and clinical benefit to ICI has been observed in several case reports.
5,6 However, to our knowledge, a comprehensive analysis of
POLE or
POLD1 mutation frequency and their predictive value for ICI treatment outcome has not yet been reported. In this study, we conducted a combined analysis using a large data set and found that
POLE/POLD1 mutations are promising potential predictive biomarkers for positive ICI outcomes.