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

Abstract

PURPOSE:

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.

• Authors: Adrienne G Waks, Daniel G Stover, Jennifer L Guerriero, Deborah Dillon, William T Barry, Evisa Gjini, Christina Hartl, Wesley Lo, Jennifer Savoie, Jane Brock, Robert Wesolowski, Zaibo Li, Adrienne Damicis, Anne V Philips, Yun Wu, Fei Yang, Amy Sullivan, Patrick Danaher, Heather Ann Brauer, Wafa Osmani, Mikel Lipschitz, Katherine A Hoadley, Michael Goldberg, Charles M Perou, Scott Rodig, Eric P Winer, Ian E Krop, Elizabeth A Mittendorf, Sara M Tolaney
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 25 Issue 15 Pg. 4644-4655 (08 01 2019) ISSN: 1557-3265 [Electronic] United States
• PMID: 31061067 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: ©2019 American Association for Cancer Research.

Chemical References

• B7-H1 Antigen
• CD274 protein, human
• ESR1 protein, human
• Estrogen Receptor alpha
• Receptors, Progesterone
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• B7-H1 Antigen (metabolism)
• Breast Neoplasms (immunology, metabolism, pathology)
• CD8-Positive T-Lymphocytes (immunology)
• Estrogen Receptor alpha (metabolism)
• Female
• Humans
• Lymphocytes, Tumor-Infiltrating (immunology)
• Middle Aged
• Neoadjuvant Therapy (methods)
• Prognosis
• Receptor, ErbB-2 (metabolism)
• Receptors, Progesterone (metabolism)
• Tumor Microenvironment (immunology)