Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
JCI Insight. 2018 Nov 15;3(22):121932. doi: 10.1172/jci.insight.121932.
Paramount to the efficacy of immune checkpoint inhibitors is proper selection of patients with adequate tumor immunogenicity and a robust but suppressed immune infiltrate. In colon cancer, immune-based therapies are approved for patients with DNA mismatch repair (MMR) deficiencies, in whom accumulation of genetic mutations results in increased neoantigen expression, triggering an immune response that is suppressed by the PD-L1/PD-1 pathway. Here, we report that characterization of the microenvironment of MMR-deficient metastatic colorectal cancer using multiplex fluorescent immunohistochemistry (mfIHC) identified increased infiltration of cytotoxic T lymphocytes (CTLs), which were more often engaged with epithelial cells (ECs) and improved overall survival. A subset of patients with intact MMR but a similar immune microenvironment to MMR-deficient patients was identified and found to universally express high levels of PD-L1, suggesting that they may represent a currently untreated, checkpoint inhibitor-responsive population. Further, PD-L1 expression on antigen-presenting cells (APCs) in the tumor microenvironment (TME) resulted in impaired CTL/EC engagement and enhanced infiltration and engagement of Tregs. Characterization of the TME by mfIHC highlights the interconnection between immunity and immunosuppression in metastatic colon cancer and may better stratify patients for receipt of immunotherapies.
免疫检查点抑制剂的疗效至关重要,这需要适当选择具有足够肿瘤免疫原性和强大但受抑制的免疫浸润的患者。在结肠癌中,免疫疗法已获批用于 DNA 错配修复 (MMR) 缺陷的患者,这些患者的遗传突变积累导致新抗原表达增加,触发免疫反应,但被 PD-L1/PD-1 通路抑制。在这里,我们报告了使用多重荧光免疫组化 (mfIHC) 对 MMR 缺陷转移性结直肠癌的微环境特征进行的研究,结果表明,细胞毒性 T 淋巴细胞 (CTL) 的浸润增加,并且这些 CTL 更常与上皮细胞 (EC) 结合,并改善了整体生存率。我们发现一部分 MMR 完整但免疫微环境与 MMR 缺陷患者相似的患者,他们普遍表达高水平的 PD-L1,这表明他们可能代表了目前未经治疗但对检查点抑制剂有反应的人群。此外,肿瘤微环境 (TME) 中抗原呈递细胞 (APC) 上的 PD-L1 表达导致 CTL/EC 结合受损,并增强了 Treg 的浸润和结合。mfIHC 对 TME 的特征描述强调了转移性结肠癌中免疫和免疫抑制之间的相互联系,并且可能更好地对接受免疫疗法的患者进行分层。