ORIGINAL RESEARCH article

Front. Immunol.

Sec. Cancer Immunity and Immunotherapy

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1540906

This article is part of the Research TopicImmune Predictive and Prognostic Biomarkers in Immuno-Oncology: Refining the Immunological Landscape of CancerView all 22 articles

Serum Extracellular Vesicle microRNAs as potential biomarkers to predict pembrolizumab response and prognosis in metastatic Non-Small Cell Lung Cancer patients

Provisionally accepted
  • 1Laboratory of preclinical and translational research, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy
  • 2Unit of Clinical Pathology, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy
  • 3Department of Onco-Hematology, Division of Medical Oncology, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy
  • 4Operative Unit of Clinical Pathology, "Renato Dulbecco" Hospital, Catanzaro, Italy
  • 5Trial Office, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy
  • 6Institute for the Sustainable Protection of Plants, Bari branch, Institute for Sustainable Plant Protection, National Research Council (CNR), Bari, Italy

The final, formatted version of the article will be published soon.

Introduction: Circulating Extracellular Vesicles (cEVs) could represent new non-invasive biomarkers for diagnosis and prognosis in tumors. In the context of Non-Small Cell Lung Cancer (NSCLC) immunotherapy there's a great need for novel predictive and prognostic biomarkers. This study aims to analyze cEVs microRNAs in serum of advanced stage NSCLC patients with PD-L1 expression ≥50% at diagnosis, before first-line pembrolizumab, to evaluate their possible role as potential biomarkers for immunotherapy response prediction and outcomes.Methods: cEVs were isolated from serum of healthy subjects and NSCLC patients at diagnosis. All patients had tumor PD-L1≥50% and cEVs were extracted before first-line pembrolizumab treatment. cEVs were then characterized for morphology, integrity, concentration, size and protein contaminants. Subsequently, microRNA content (miR-10a, miR-21, miR-22, miR-30a, miR-34a, miR-106b, miR-125b, miR-150, miR-155, miR-181a, miR-181b, miR-451a) was investigated by digital PCR. Additionally, miRNA-targets and their roles were evaluated. All data were associated with immunotherapy response, Progression Free Survival (PFS), Overall Survival (OS), Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and metastases.Results: Twelve NSCLC-related microRNAs have been found, for the first time, in serum cEVs from a specific cohort of metastatic advanced stage NSCLC patients. Through a functional analysis, these microRNAs are found to be connected to each other and involved in the pathology of NSCLC, particularly in IGF/P53/VEGF/NOTCH/PI3K pathways, in cytokine/interleukin signaling and in the immune system. Specifically, we demonstrated that cEV miR-106b, miR-451a, miR-181 and miR-10a were significantly upregulated in non-responder patients compared to responder ones (p-value=0.08-0.1) predicting with high accuracy, already at diagnosis, treatment response. Furthermore, a low level of all these microRNAs predicted improved PFS (p-value=0.009-0.02) and a low amount of miR-106b predicted longer OS (p=0.069). In addition, it was observed that high levels of miR-106b and miR-451a are indicative of a high number of metastases (p=0.05/0.04, respectively) and of ECOG-PS=0.Discussion: This is the first study that investigated specific potential serum cEV miRNAs to predict with high accuracy immunotherapy response and prognosis in specific metastatic NSCLC patients, already at diagnosis. Collectively, our cEV miRNA analysis identifies novel circulating biomarkers that are easily accessible and non-invasive, offering a potential blood-based tool to guide personalized medicine in NSCLC.

Keywords: NSCLC, Immunotherapy, liquid biopsy, biomarkers, extracellular vesicles, MicroRNAs, Response prediction, prognosis

Received: 06 Dec 2024; Accepted: 07 May 2025.

Copyright: © 2025 Lamorte, De Luca, Tartarone, Trino, Giulivo, De Stradis, Maietti, Caivano and Laurenzana. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Luciana De Luca, Unit of Clinical Pathology, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy
Antonella Caivano, Unit of Clinical Pathology, IRCCS Centro di Riferimento Oncologico della Basilicata CROB, Rionero in Vulture, Italy

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