Background Immunotherapies have induced long-lasting remissions in countless advanced-stage cancer patients, but many more patients have not benefitted. Therefore, novel predictive markers are needed to stratify patients before treatment and select those who will most likely benefit from immunotherapy, while avoiding potentially devastating adverse effects and high treatment costs for those who will not. We reasoned that thoroughly characterizing the architecture of the tumor microenvironment (TME) at the single-cell level by highly multiplexed tissue imaging should reveal novel spatial biomarkers of immunotherapy response.
Materials and Methods We used CODEX (CO-Detection by indEXing) highly multiplexed fluorescence microscopy to investigate the TME of cutaneous T cell lymphoma (CTCL) in samples from patients treated with pembrolizumab. 55 protein markers were visualized simultaneously using a tissue microarray of matched pre- and post-treatment skin biopsies from 7 pembrolizumab responders and 7 non-responders. After computational image processing and extraction of single-cell information, cell types were identified by unsupervised clustering followed by supervised curation, and cell-cell distances and ‘cellular neighborhoods’ were computed. We also performed RNA sequencing on laser-capture microdissected tissue microarray cores to extract cell-type specific gene expression profiles by CIBERSORTx analysis.
Results CODEX enabled the identification and characterization of malignant CD4+ tumor cells and reactive immune cells in the CTCL TME at the single-cell level, resulting in 21 different cell type clusters with spatial information. Cluster frequencies were not significantly different between responders and non-responders pre- and post-treatment. However, advanced computational analysis of the tumor architecture revealed cellular neighborhoods (CNs) that dynamically changed during pembrolizumab therapy and were correlated with response. Effector-type CNs enriched in tumor-infiltrating CD4+ T cells and dendritic cells were significantly increased after treatment in responders. In contrast, a regulatory T cell-enriched CN was significantly increased in non-responders before and after therapy. Furthermore, a spatial signature of cell-cell distances between tumor cells and effector/regulatory immune cells predicted therapy outcome. In addition, CIBERSORTx analysis revealed that tumor cells in responders, but not in non-responders, increased their expression of immune-activating genes.
Conclusions High-dimensional spatial analysis of CTCL tumors revealed a pre-existing immunosuppressive state in pembrolizumab non-responders. Thorough analysis of the TME therefore enables the discovery of novel spatial biomarkers in a concept that accounts for both cell type information and higher-order tumor architecture. Combining highly multiplexed microscopy with CIBERSORTx allows for the discovery of novel, predictive spatial biomarkers of immunotherapy response and will pave the way for future studies that functionally address these cell types and their interactions.
Disclosure Information C.M. Schürch: F. Consultant/Advisory Board; Modest; Enable Medicine, LLC. D.J. Phillips: None. M. Matusiak: None. B. Rivero Gutierrez: None. S.S. Bhate: None. G.L. Barlow: None. M.S. Khodadoust: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Significant; Corvus Pharmaceuticals. R. West: None. Y.H. Kim: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Significant; Merck, Horizon, Soligenix, miRagen, Forty Seven Inc., Neumedicine, Trillium, Galderma, Elorac. D. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); Significant; Innate Pharma, Eisai, Kyowa Hakko Kirin, Takeda, Seattle Genetics, Medivir, Portola Pharmaceuticals, Corvus Pharmaceuticals. G.P. Nolan: E. Ownership Interest (stock, stock options, patent or other intellectual property); Significant; Akoya Biosciences. F. Consultant/Advisory Board; Significant; Akoya Biosciences.
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