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Clin Cancer Res. 2019 May 6. doi: 10.1158/1078-0432.CCR-19-0173. [Epub ahead of print]

The Immune Microenvironment in Hormone Receptor-Positive Breast Cancer Before and After Preoperative Chemotherapy.

Author information

1
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
2
Division of Medical Oncology, Ohio State University College of Medicine, Columbus, Ohio.
3
Breast Tumor Immunology Laboratory, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts.
4
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
5
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
6
Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts.
7
Department of Pathology, Ohio State University College of Medicine, Columbus, Ohio.
8
Department of Biostatistics, Ohio State University College of Public Health, Columbus, Ohio.
9
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
11
Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
12
NanoString Technologies, Seattle, Washington.
13
University of North Carolina School of Medicine, Chapel Hill, North Carolina.
14
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
15
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. sara_tolaney@dfci.harvard.edu.
#
Contributed equally

Abstract

Background: Hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer is associated with low levels of stromal tumor-infiltrating lymphocytes (sTIL) and PD-L1, and demonstrates poor responses to checkpoint inhibitor therapy. Evaluating the effect of standard chemotherapy on the immune microenvironment may suggest new opportunities for immunotherapy-based approaches to treating HR+/HER2- breast tumors.Experimental Design: HR+/HER2- breast tumors were analyzed before and after neoadjuvant chemotherapy. sTIL were assessed histologically; CD8+ cells, CD68+ cells, and PD-L1 staining were assessed immunohistochemically; whole transcriptome sequencing and panel RNA expression analysis (NanoString) were performed.Results: Ninety-six patients were analyzed from two cohorts (n = 55, Dana-Farber cohort; n = 41, MD Anderson cohort). sTIL, CD8, and PD-L1 on tumor cells were higher in tumors with basal PAM50 intrinsic subtype. Higher levels of tissue-based lymphocyte (sTIL, CD8, PD-L1) and macrophage (CD68) markers, as well as gene expression markers of lymphocyte or macrophage phenotypes (NanoString or CIBERSORT), correlated with favorable response to neoadjuvant chemotherapy, but not with improved distant metastasis-free survival in these cohorts or a large gene expression dataset (N = 302). In paired pre-/postchemotherapy samples, sTIL and CD8+ cells were significantly decreased after treatment, whereas expression analyses (NanoString) demonstrated significant increase of multiple myeloid signatures. Single gene expression implicated increased expression of immunosuppressive (M2-like) macrophage-specific genes after chemotherapy.Conclusions: The immune microenvironment of HR+/HER2- tumors differs according to tumor biology. This cohort of paired pre-/postchemotherapy samples suggests a critical role for immunosuppressive macrophage expansion in residual disease. The role of macrophages in chemoresistance should be explored, and further evaluation of macrophage-targeting therapy is warranted.

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