Clin Cancer Res. 2023 Jul 13. pii: CCR-22-3964. [Epub ahead of print]
Claire Gallois,
Matteo Landi,
Julien Taieb,
Marine Sroussi,
Bahar Saberzadeh-Ardestani,
Antoine Cazelles,
Sara Lonardi,
Francesca Bergamo,
Rossana Intini,
Giulia Maddalena,
Filippo Pietrantonio,
Francesca Corti,
Margherita Ambrosini,
Antonia Martinetti,
Marco Maria Germani,
Chiara Boccaccio,
Guglielmo Vetere,
Sophie Mouillet-Richard,
Aurelien de Reynies,
Frank A Sinicrope,
Chiara Cremolini,
Pierre Laurent-Puig.
PURPOSE: Microsatellite instability (MSI) is currently the only predictive biomarker of efficacy of immune checkpoint inhibitors (ICI) in metastatic colorectal cancers (mCRC). However, 10-40% of patients with MSI mCRC will experience a primary resistance to ICI.EXPERIMENTAL DESIGN: In 2 cohorts of patients with MSI mCRC treated with ICI (exploratory: N=103, validation: N=35), 3'RNAseq was performed from primary tumors. Previously described single-cell transcriptomic signatures of tumor microenvironment (TME) were analysed.
RESULTS: In the exploratory cohort, the unsupervised clustering allowed the identification of three clusters of tumors with distinct transcriptional profiles: cluster A ("stromalHIGH-proliferationLOW"), cluster B ("stromalHIGH-proliferationMED"), and cluster C ("stromalLOW-proliferationHIGH"), with an enrichment of patients progressing at first disease assessment under ICI in the cluster A (30% vs 12% in cluster B and 8.1% in cluster C, p=0.074). Progression-free survival (PFS) was also significantly shorter in patients belonging to cluster A, compared to clusters B or C (p<0.001) with 2-year PFS rates of 33.5%, 80.5% and 78.3%, respectively. In multivariate analysis, PFS was still significantly longer in patients belonging to cluster B (HR: 0.19 95%CI 0.08-0.45, p<0.001) and cluster C (HR: 0.25 95%CI 0.10-0.59, p=0.02), compared to patients belonging to cluster A. The association of this clustering with PFS under ICI was confirmed in the validation cohort. PFS related to non-ICI-based regimens was not significantly different according to cluster.
CONCLUSION: This unsupervised transcriptomic classification identified three groups of MSI mCRCs with different compositions of TME cells and proliferative capacities of TME/tumor cells. The "stromalHIGH-proliferationLOW" cluster is associated with a poorer prognosis with ICI treatment.