DUX4 is a common driver of immune evasion and immunotherapy failure in metastatic cancers.

Abstract

Cancer immune evasion contributes to checkpoint immunotherapy failure in many patients with metastatic cancers. The embryonic transcription factor DUX4 was recently characterized as a suppressor of interferon-γ signaling and antigen presentation that is aberrantly expressed in a small subset of primary tumors. Here, we report that <i>DUX4</i> expression is a common feature of metastatic tumors, with ~10-50% of advanced bladder, breast, kidney, prostate, and skin cancers expressing <i>DUX4. DUX4</i> expression is significantly associated with immune cell exclusion and decreased objective response to PD-L1 blockade in a large cohort of urothelial carcinoma patients. <i>DUX4</i> expression is a significant predictor of survival even after accounting for tumor mutational burden and other molecular and clinical features in this cohort, with <i>DUX4</i> expression associated with a median reduction in survival of over 1 year. Our data motivate future attempts to develop DUX4 as a biomarker and therapeutic target for checkpoint immunotherapy resistance.