Figure 4 from Combined Immunotherapy Improves Outcome for Replication-Repair-Deficient (RRD) High-Grade Glioma Failing Anti–PD-1 Monotherapy: A Report from the International RRD Consortium

Patients treated with nivolumab and trametinib (n = 5). A, Objective responses in bifocal glioblastoma progressing on nivolumab. B, Swimmer's plot summarizing events in each patient. C, The patient progressing at primary and distant sites on nivolumab had complete response on being simultaneously treated with radiation and addition of trametinib to nivolumab. T-cell receptor (TCR) clonotype analysis shows an initial increase in TCRB after starting on nivolumab, and invigoration of response at salvage treatment postprogression. This was observed both in terms of increased absolute clonal counts after adding trametinib, as well as clonal selection, plausibly for more tumor-specific TCR clones (as shown by the colored bars), as this correlated with the response seen in radiology. MEK-i, MEK inhibitor.