Cancer immunotherapy, including immune checkpoint blocking antibodies are important components for treatment of patients with various types of cancer as they enhance the ability of the immune system to fight tumours. However, tumor cells have the ability to develop resistance to a variety of transitional therapies such as chemotherapy. In this study, in vitro Tumour-Immune co-culture system (TICS) has been developed to evaluate the impact on the antitumor activity of the primary human lymphocytes and response to PD-1 (nivolumab) and PD-L1 (durvalumab) checkpoint blocking antibodies against acquired chemotherapy resistance cancer cell lines. Using paired ovarian and neuroblastoma cancer cell lines obtained prior to chemotherapy (naïve) and after chemotherapy resistance, the results show that resistant ovarian cancer cells have differential effect on activation of lymphocytes and respond poorly to nivolumab and durvalumab, compared to chemotherapy naïve cells. On the other hand, chemotherapy neuroblastoma resistance cells show to respond to PD-1/L1 blockade therapy in TICS. Furthermore, blocking important molecular interactions between cancer cells and human lymphocytes such as HLA-ABC, HLA-DR and IFN-γ receptor compromises response to immune checkpoint blockade. In accordance, deletion of programmed death ligand 1 (PD-L1) on cancer cells by the CRISPR/Cas9 system significantly increases antitumor activity of immune cells in TICS. Moreover, deletion of beta-2-microglobulin (B2M) on human cancer cells resulted in substantial downregulation of HLA-ABC, which influenced immune activation induced by PD-1 blockade. Together, these findings demonstrate that chemotherapy resistance in human cancer cells could limit efficient response of PD-1/L1 blockade and thus immune checkpoint therapy could be more effective in early stage cancers.

L’avènement des inhibiteurs du point de contrôle immunitaire (ICIs) ciblant l’axe PD-1/PD-L1 a révolutionné le traitement des patients avec un carcinome pulmonaire non à petites cellules (CPNPC). Ce mémoire consolide les conclusions de trois études distinctes visant à analyser et à améliorer l'efficacité des ICIs en monothérapie chez le CPNPC. La première section explore les bénéfices associés au durvalumab suivant une chimioradiothérapie chez les patients présentant un CPNPC localement avancé, confirmant le bénéfice de survie associé aux ICI et élargissant les perspectives émises depuis l'étude PACIFIC, y compris au niveau de la valeur prédictive du PD-L1. Dans l’optique de caractériser de nouveaux biomarqueurs d’efficacité, la deuxième section souligne le rôle crucial du microbiome intestinal dans la modulation de la réponse aux ICIs, spécifiquement au niveau de la dysbiose intestinale liée aux antibiotiques. La méta-analyse proposée confirme l’impact délétère des antibiotiques sur la survie des patients traités avec un ICI, tout particulièrement lorsque l’antibiothérapie précède l’inhibition du PD-1/PD-L1. Dans le domaine des stratégies immunomodulatrices émergentes, la troisième section explore l’impact de la cryoablation chez les patients présentant un CPNPC avec PD-L1≥50% et traités avec le pembrolizumab. Sans relever un signal d’efficacité supérieure, cette étude de phase I/II confirme la faisabilité et l’innocuité de la cryoablation, une technique permettant la libération d’antigènes tumoraux en circulation sans dénaturation thermique. Ultimement, ce mémoire propose un survol des bénéfices de survie, biomarqueurs prédictifs et stratégies immunomodulatrices liés à l’utilisation des ICIs chez les patients avec un CPNPC avec l’espoir d’optimiser les paradigmes thérapeutiques existants. / The advent of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis has revolutionized the therapeutic landscape for patients diagnosed with non-small cell lung cancer (NSCLC). This thesis consolidates the findings of three distinct studies aiming to analyze and enhance the efficacy of ICI monotherapy in NSCLC. The first section delves into the real-world use of durvalumab following chemoradiotherapy in stage III NSCLC, confirming the survival benefit associated with ICI administration in this context and broadening the insights derived from the PACIFIC study, particularly regarding the predictive value of PD-L1. With the aim of characterizing new biomarkers of efficacy, the second section sheds light on the crucial role of the gut microbiome in modulating responses to ICIs, particularly intestinal dysbiosis related to antibiotics. The meta-analysis confirms the detrimental impact of antibiotics on the overall survival of patients with advanced cancer treated with ICI monotherapy, especially when antibiotic therapy precedes PD-1/PD-L1 inhibition. In the realm of emerging immunomodulatory strategies, the third section explores the impact of cryoablation in patients with NSCLC and PD-L1≥50% treated with pembrolizumab. Although the procedure did not translate into a signal of superior efficacy, the proposed phase I/II study confirms the feasibility and safety of cryoablation, a technique allowing the release of circulating tumor antigens without heat-related denaturation. Ultimately, this thesis presents a contemporary overview of survival benefits, predictive biomarkers, and immunomodulatory strategies associated with the use of ICIs in monotherapy in patients with NSCLC, with the hope of optimizing existing therapeutic paradigms.