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      Predicting patient outcomes after treatment with immune checkpoint blockade: A review of biomarkers derived from diverse data modalities

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          Summary

          Immune checkpoint blockade (ICB) therapy targeting cytotoxic T-lymphocyte-associated protein 4, programmed death 1, and programmed death ligand 1 has shown durable remission and clinical success across different cancer types. However, patient outcomes vary among disease indications. Studies have identified prognostic biomarkers associated with immunotherapy response and patient outcomes derived from diverse data types, including next-generation bulk and single-cell DNA, RNA, T cell and B cell receptor sequencing data, liquid biopsies, and clinical imaging. Owing to inter- and intra-tumor heterogeneity and the immune system’s complexity, these biomarkers have diverse efficacy in clinical trials of ICB. Here, we review the genetic and genomic signatures and image features of ICB studies for pan-cancer applications and specific indications. We discuss the advantages and disadvantages of computational approaches for predicting immunotherapy effectiveness and patient outcomes. We also elucidate the challenges of immunotherapy prognostication and the discovery of novel immunotherapy targets.

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          Abstract

          Liu et al. reviewed recently developed biomarkers derived from multi-omics and multi-modality data resources for predicting cancer patient outcomes treated with immune checkpoint blockade therapy. These biomarkers play an important role in patient selection for clinical decision-making, offer insights into mechanisms driving tumor-cell-intrinsic and -extrinsic heterogeneity, and contribute to discovering novel therapeutic targets. As immunotherapy advances, the integration of advanced computational approaches with ever-expanding data resources promises continued progress and substantial benefits for cancer patients.

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          Most cited references155

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          Signatures of T cell dysfunction and exclusion predict cancer immunotherapy response

          Cancer treatment by immune checkpoint blockade (ICB) can bring long-lasting clinical benefits, but only a fraction of patients respond to treatment. To predict ICB response, we developed TIDE, a computational method to model two primary mechanisms of tumor immune evasion: the induction of T cell dysfunction in tumors with high infiltration of cytotoxic T lymphocytes (CTL) and the prevention of T cell infiltration in tumors with low CTL level. We identified signatures of T cell dysfunction from large tumor cohorts by testing how the expression of each gene in tumors interacts with the CTL infiltration level to influence patient survival. We also modeled factors that exclude T cell infiltration into tumors using expression signatures from immunosuppressive cells. Using this framework and pre-treatment RNA-Seq or NanoString tumor expression profiles, TIDE predicted the outcome of melanoma patients treated with first-line anti-PD1 or anti-CTLA4 more accurately than other biomarkers such as PD-L1 level and mutation load. TIDE also revealed new candidate ICB resistance regulators, such as SERPINB9 , demonstrating utility for immunotherapy research.
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            Cancer immunotherapy using checkpoint blockade

            The release of negative regulators of immune activation (immune checkpoints) that limit antitumor responses has resulted in unprecedented rates of long-lasting tumor responses in patients with a variety of cancers. This can be achieved by antibodies blocking the cytotoxic T lymphocyte antigen-4 (CTLA-4) or the programmed death-1 (PD-1) pathway, either alone or in combination. The main premise for inducing an immune response is the pre-existence of antitumor T cells that were limited by specific immune checkpoints. Most patients who have tumor responses maintain long lasting disease control, yet one third of patients relapse. Mechanisms of acquired resistance are currently poorly understood, but evidence points to alterations that converge on the antigen presentation and interferon gamma signaling pathways. New generation combinatorial therapies may overcome resistance mechanisms to immune checkpoint therapy.
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              PD-1 blockade induces responses by inhibiting adaptive immune resistance

              Therapies that target the programmed death-1 (PD-1) receptor have shown unprecedented rates of durable clinical responses in patients with various cancer types. 1–5 One mechanism by which cancer tissues limit the host immune response is via upregulation of PD-1 ligand (PD-L1) and its ligation to PD-1 on antigen-specific CD8 T-cells (termed adaptive immune resistance). 6,7 Here we show that pre-existing CD8 T-cells distinctly located at the invasive tumour margin are associated with expression of the PD-1/PD-L1 immune inhibitory axis and may predict response to therapy. We analyzed samples from 46 patients with metastatic melanoma obtained before and during anti-PD1 therapy (pembrolizumab) using quantitative immunohistochemistry, quantitative multiplex immunofluorescence, and next generation sequencing for T-cell receptors (TCR). In serially sampled tumours, responding patients showed proliferation of intratumoural CD8+ T-cells that directly correlated with radiographic reduction in tumour size. Pre-treatment samples obtained from responding patients showed higher numbers of CD8, PD1, and PD-L1 expressing cells at the invasive tumour margin and inside tumours, with close proximity between PD-1 and PD-L1, and a more clonal TCR repertoire. Using multivariate analysis, we established a predictive model based on CD8 expression at the invasive margin and validated the model in an independent cohort of 15 patients. Our findings indicate that tumour regression following therapeutic PD-1 blockade requires pre-existing CD8+ T cells that are negatively regulated by PD-1/PD-L1 mediated adaptive immune resistance.
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                Author and article information

                Contributors
                Journal
                Cell Genom
                Cell Genom
                Cell Genomics
                Elsevier
                2666-979X
                21 November 2023
                10 January 2024
                21 November 2023
                : 4
                : 1
                : 100444
                Affiliations
                [1 ]Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 02115, USA
                [2 ]Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
                [3 ]Department of Biomedical Informatics, Harvard Medical School, Boston, MA 20115, USA
                [4 ]Harvard Medical School, Boston, MA 02115, USA
                [5 ]The Eli and Edythe Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA
                [6 ]Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
                [7 ]Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
                [8 ]Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA
                [9 ]Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, MA 02138, USA
                [10 ]The Ludwig Center at Harvard, Boston, MA 02115, USA
                Author notes
                []Corresponding author michor@ 123456jimmy.harvard.edu
                Article
                S2666-979X(23)00279-3 100444
                10.1016/j.xgen.2023.100444
                10794784
                38190106
                5fde6194-2eaf-400f-9c9e-c2874c1ac20a
                © 2023.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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