Spatiotemporal Immune Determinants of Response to Immune Rechallenge in Advanced Cervical Cancer

Although immune checkpoint inhibitors (ICI) show durable responses in various cancers, relapse remains common. The efficacy of retreatment with ICIs is controversial. We conducted a multicenter, single-arm, phase II trial (NCT05824468), including 30 patients with advanced cervical cancer who experienced disease progression on or after prior ICI therapy. Participants received a combined regimen of zimberelimab and lenvatinib (immune rechallenge). Single-cell multiomics analysis of sequential biopsies of relapsed tumors and blood samples showed that immune rechallenge induced a more cytotoxic phenotype in CD8+ T cells in responders, whereas a natural killer-like CD8+ T and progenitor-exhausted CD8+ T phenotype was observed in the blood of nonresponders. In tumors, responders showed more effector memory CD8+ T cells and reduced exhausted CD8+ T cells after treatment. A population of CD45+CD3+Lyz+ dyad cells, composed of T cells and myeloid cells, was correlated with clinical benefit. Our findings proved that immune rechallenge could be an effective treatment for patients with advanced cervical cancer whose disease progressed on or after prior ICI therapy. SIGNIFICANCE: This study highlights response heterogeneity within patients with advanced cervical cancer with progressive disease on prior ICIs to immune rechallenge and underscores its potential feasibility. Spatiotemporal genomic and immunologic alterations are critical treatment biomarkers to identify responders in future clinical practice.