O'Meara Tess, Marczyk Michal, Qing Tao, Yaghoobi Vesal, Blenman Kim, Cole Kimberly, Pelekanou Vasiliki, Rimm David L, Pusztai Lajos
Department of Medical Oncology, Yale School of Medicine, New Haven, CT.
Data Mining Division, Silesian University of Technology, Gliwice, Poland.
JCO Precis Oncol. 2020 Jun 26;4. doi: 10.1200/PO.19.00350. eCollection 2020.
PURPOSE: A subset of estrogen receptor-positive (ER-positive) breast cancer (BC) contains high levels of tumor-infiltrating lymphocytes (TILs), similar to triple-negative BC (TNBC). The majority of immuno-oncology trials target TNBCs because of the greater proportion of TIL-rich TNBCs. The extent to which the immune microenvironments of immune-rich ER-positive BC and TNBC differ is unknown. PATIENTS AND METHODS: RNA sequencing data from The Cancer Genome Atlas (TCGA; n = 697 ER-positive BCs; n = 191 TNBCs) were used for discovery; microarray expression data from Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n = 1,186 ER-positive BCs; n = 297 TNBCs) was used for validation. Patients in the top 25th percentile of a previously published total TIL metagene score distribution were considered immune rich. We compared expression of immune cell markers, immune function metagenes, and immuno-oncology therapeutic targets among immune-rich subtypes. RESULTS: Relative fractions of resting mast cells (TCGA = .009; METABRIC = 4.09E-15), CD8 T cells (TCGA = .015; METABRIC = 0.390), and M2-like macrophages (TCGA = 4.68E-05; METABRIC = .435) were higher in immune-rich ER-positive BCs, but M0-like macrophages (TCGA = 0.015; METABRIC = .004) and M1-like macrophages (TCGA = 9.39E-08; METABRIC = 6.24E-11) were higher in immune-rich TNBCs. Ninety-one immune-related genes (eg, , , , , ) and a transforming growth factor β (TGF-β) response metagene were significantly overexpressed in immune-rich ER-positive BCs, whereas 41 immune-related genes (eg, , , , ) were overexpressed in immune-rich TNBCs in both discovery and validation data sets. TGF-β pathway member genes correlated negatively with expression of immune activation markers (, granzyme-B, perforin) and positively with M2-like macrophages (, , and and regulatory T-cell () markers in both subtypes. CONCLUSION: Different immunotherapy strategies may be optimal in immune-rich ER-positive BC and TNBC. Drugs targeting the TGF-β pathway and M2-like macrophages are promising strategies in immune-rich ER-positive BCs to augment antitumor immunity.
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