Multiplex IHC Research Articles

Components of the tumor immune microenvironment based on m-IHC correlate with prognosis and subtype of triple-negative breast cancer.

The spatial distribution and interactions of cells in the tumor immune microenvironment (TIME) might be related to the different responses of triple-negative breast cancer (TNBC) to immunomodulators. The potential of multiplex IHC (m-IHC) in evaluating the TIME has been reported, but the efficacy is insufficient. We aimed to research whether m-IHC results could be used to reflect the TIME, and thus to predict prognosis and complement the TNBC subtyping system. The clinical, imaging, and prognosis data for 86 TNBC patients were retrospectively reviewed. CD3, CD4, CD8, Foxp3, PD-L1, and Pan-CK markers were stained by m-IHC. Particular cell spatial distributions and interactions in the TIME were evaluated with the HALO multispectral analysis platform. Then, we calculated the prognostic value of components of the TIME and their correlations with TNBC transcriptomic subtypes and MRI radiomic features reflecting TNBC subtypes. The components of the TIME score were established by m-IHC and demonstrated positive prognostic value for TNBC (p = 0.0047, 0.039, <0.0001 for DMFS, RFS, and OS). The score was calculated from several indicators, including Treg% in the tumor core (TC) or stromal area (SA), PD-L1+ cell% in the SA, CD3 + cell% in the TC, and PD-L1+ /CD8+ cells in the invasive margin and SA. According to the TNBC subtyping system, a few TIME indicators were significantly different in different subtypes and significantly correlated with MRI radiomic features reflecting TNBC subtypes. We demonstrated that the m-IHC-based quantitative score and indicators related to the spatial distribution and interactions of cells in the TIME can aid in the accurate diagnosis of TNBC in terms of prognosis and classification.

Tumor-Infiltrating CD103+ Tissue-Resident Memory T Cells and CD103-CD8+ T Cells in HNSCC Are Linked to Outcome in Primary but not Metastatic Disease.

High numbers of tumor-infiltrating lymphocytes (TIL) are linked to better survival in patients with cancer. Tissue-resident memory T cells (TRM; CD8+CD103+) are recognized as a key player of anticancer immune response. To assess TRM cells in primary, metastatic, and recurrent head and neck squamous cell carcinoma (HNSCC), we developed a tissue microarray (TMA) and used multiplex IHC (MxIHC). Samples from primary tumors of 379 HNSCC cases treated at Southampton Hospitals between 2000 and 2016 were collected and analyzed. Of these, 105 cases had lymph node metastases and 82 recurrences. A TMA was generated with triplicate cores for each sample. MxIHC with a stain-and-strip approach was performed using CD8, CD103, and TIM3. Scanned slides were analyzed (digital image analysis) and quality checked (QC). After QC, 194 primary tumors, 76 lymph node metastases, and 65 recurrences were evaluable. Alcohol consumption was statistically significantly correlated with a reduction of TRM cells in primary tumors (nondrinker vs. heavy drinker: P = 0.0036). The known survival benefit of TRM cell infiltration in primary tumors was not found for lymph node metastasis. In recurrences, a high TRM cell number led to a favorable outcome after 12 months. The checkpoint molecule TIM3, was expressed significantly higher on TRM and non-TRM cells in the lymph node compared with primary tumors (P < 0.0001), which was also seen in recurrences (P = 0.0134 and P = 0.0007, respectively). We confirm the prognostic impact of TIL in primary tumors and in recurrences. TRM cell density in lymph node metastases was not linked to outcome. The role of TIM3, as a therapeutic target remains to be defined.

Characterization of Immunosuppressive Myeloid Cells in Merkel Cell Carcinoma: Correlation with Resistance to PD-1 Pathway Blockade.

Merkel cell carcinoma (MCC) is a highly immunogenic skin cancer. Although essentially all MCCs are antigenic through viral antigens or high tumor mutation burden, MCC has a response rate of only approximately 50% to PD-(L)1 blockade suggesting barriers to T-cell responses. Prior studies of MCC immunobiology have focused on CD8 T-cell infiltration and their exhaustion status, while the role of innate immunity, particularly myeloid cells, in MCC remains underexplored. We utilized single-cell transcriptomics from 9 patients with MCC and multiplex IHC staining of 54 patients' preimmunotherapy tumors, to identify myeloid cells and evaluate association with immunotherapy response. Single-cell transcriptomics identified tumor-associated macrophages (TAM) as the dominant myeloid component within MCC tumors. These TAMs express an immunosuppressive gene signature characteristic of monocytic myeloid-derived suppressor cells and importantly express several targetable immune checkpoint molecules, including PD-L1 and LILRB receptors, that are not present on tumor cells. Analysis of 54 preimmunotherapy tumor samples showed that a subset of TAMs (CD163+, CD14+, S100A8+) selectively infiltrated tumors that had significant CD8 T cells. Indeed, higher TAM prevalence was associated with resistance to PD-1 blockade. While spatial interactions between TAMs and CD8 T cells were not associated with response, myeloid transcriptomic data showed evidence for cytokine signaling and expression of LILRB receptors, suggesting potential immunosuppressive mechanisms. This study further characterizes TAMs in MCC tumors and provides insights into their possible immunosuppressive mechanism. TAMs may reduce the likelihood of treatment response in MCC by counteracting the benefit of CD8 T-cell infiltration. See related commentary by Silk and Davar, p. 1076.

Combination of BET Inhibition with Radiation Induces Anti-Tumor Immune Response in Pre-Clinical Models of ER-Positive Breast Cancer

Despite advances in multidisciplinary care, the risk of late recurrence in Estrogen Receptor-positive (ER+) breast cancer (BC) patients following standard-of-care treatment ranges from 20-52% at 20 years. While immune checkpoint inhibitors (CPI), have shown enormous potential in inducing long term remission in some cases, patients with ER+ BC show poor response to these agents. The objective of this study is to develop effective radiation therapy (RT)-based combination regimens that induce anti-tumor immunity against immunologically cold ER+ breast tumors. We have previously shown that pharmacological inhibition of bromodomain and extraterminal domain (BET) family of epigenetic regulator proteins overcomes both endocrine therapy resistance and radiation resistance in pre-clinical models of ER+ BC by reversing pathological reprogramming of transcriptional and DNA repair pathways, respectively. In this study, we explore the potential of RT+BET inhibition combination to elicit anti-tumor immunity against ER+ BC. A unique ER+ BC model, MXT+, was used to generate tumors in female, BDF1 mice. PD-L1 expression following RT or RT+OTX015 (a BET inhibitor) was assessed by Western blot analysis. Comet assay was used to assess the degree of unrepaired DNA damage following treatment with RT alone, OTX015 alone and RT+OTX015. Multiplex IHC was used to assess changes in tumor microenvironment after various treatments. Tumor growth characteristics were established following treatment with vehicle, RT alone (8 Gy x 3), OTX015 alone (100 mg/kg x 3 days) and RT+OTX015. Using murine ER+ BC model, MXT+, we show that RT is a potent inducer of PD-L1 expression. Combination of RT+OTX015 completely ablated RT-mediated PD-L1 induction at the transcription level. OTX015 also accentuated RT-induced DNA damage through inhibition of NHEJ pathway, resulting in increased micronuclei formation (which activate cGAS/STING pathway, a critical bridge between innate and adaptive immunity). Combination of OTX015 with RT also caused a statistically significant (on unpaired t test) increase tumor infiltrating lymphocytes. In in vivo therapeutic studies, combination of OTX015 with RT (8 Gy x 3) resulted in extraordinary synergy and caused complete inhibition of long-term tumor growth. Treatment with RT alone (8 Gy x 3) or OTX015 alone (on 3 consecutive days) only caused modest inhibition of tumor growth. ANOVA with Dunnett's test was used to adjust for multiple comparisons and showed statistically significant difference in tumor growth between OTX015+RT arm and OTX alone as well as OTX015+RT arm and RT alone. Patients with ER+ BC face high risk of late recurrence after definitive treatment and show poor response to immune CPIs. We show that combination of BET inhibition with RT induces anti-tumor immunity and completely prevents tumor growth. Clinical validation of this regimen is warranted to prevent late recurrences in ER+ BC patients.

Tumor-Infiltrating Normal B Cells Revealed by Immunoglobulin Repertoire Clonotype Analysis Are Highly Prognostic and Crucial for Antitumor Immune Responses in DLBCL.

Tumor-infiltrating B lymphocytes (TIL-B) have demonstrated prognostic and predictive significance in solid cancers. In this study, we aimed to distinguish TIL-Bs from malignant B-cells in diffuse large B-cell lymphoma (DLBCL) and determine the clinical and biological significance. A total of 269 patients with de novo DLBCL from the International DLBCL R-CHOP Consortium Program were studied. Ultra-deep sequencing of the immunoglobulin genes was performed to determine B-cell clonotypes. The frequencies and numbers of TIL-B clonotypes in individual repertoires were correlated with patient survival, gene expression profiling (GEP) data, and frequencies of DLBCL-infiltrating immune cells quantified by fluorescent multiplex IHC at single-cell resolution. TIL-B abundance, evaluated by frequencies of normal B-cell clonotypes in the immunoglobulin repertoires, remarkably showed positive associations with significantly better survival of patients in our sequenced cohorts. DLBCLs with high versus low TIL-B abundance displayed distinct GEP signatures, increased pre-memory B-cell state and naïve CD4 T-cell state fractions, and higher CD4+ T-cell infiltration. TIL-B frequency, as a new biomarker in DLBCL, outperformed the germinal center (GC) B-cell-like/activated B-cell-like classification and TIL-T frequency. The identified TIL-B-high GEP signature, including genes upregulated during T-dependent B-cell activation and those highly expressed in normal GC B cells and T cells, showed significant favorable prognostic effects in several external validation cohorts. TIL-B frequency is a significant prognostic factor in DLBCL and plays a crucial role in antitumor immune responses. This study provides novel insights into the prognostic determinants in DLBCL and TIL-B functions with important therapeutic implications.

Treatment Response in First-Line Metastatic Pancreatic Ductal Adenocarcinoma Is Stratified By a Composite Index of Tumor Proliferation and CD8 T-Cell Infiltration.

Determinants of treatment outcomes to chemotherapy-based regimens in metastatic pancreatic ductal adenocarcinoma (PDA) remain ill-defined. Our aim was to examine tissue-based correlates of treatment response and resistance using matched baseline and on-treatment biopsies collected from patients with PDA treated in the first-line metastatic setting. Patients with treatment-naïve metastatic PDA were enrolled in a Phase II trial (NCT02077881) investigating gemcitabine plus nab-paclitaxel in combination with indoximod, an orally administered small-molecule inhibitor of the IDO pathway. Baseline and on-treatment biopsies (week 8) of metastatic lesions (88% liver) were collected from a cohort of responders (N = 8) and non-responders (N = 8) based on RECIST v1.1 and examined by multiplex IHC and mRNA sequencing. Treatment altered the transcriptional profile of metastatic lesions with a decrease in tumor cell proliferation independent of treatment response. The antiproliferative response was seen in both basal and classical PDA subtypes. PDA subtype was not associated with survival outcomes; instead, genes involved in immune activation distinguished responders from non-responders. Tumor response was associated with an increase in CD3+ and CD8+ T-cell infiltrates into metastatic lesions. A composite of decreased tumor proliferation in response to treatment and increased CD8 T-cell infiltration in metastatic lesions identified responders and associated with a favorable survival outcome. Our findings suggest that inhibiting cancer cell proliferation alone in PDA is insufficient to produce tumor responses and support a role for tumor-extrinsic mechanisms, such as CD8+ T cells, which combine with the cancer cell proliferation index to define treatment outcomes.

Cancer associated fibroblast derived SLIT2 drives gastric cancer cell metastasis by activating NEK9

The secretory properties of cancer-associated fibroblasts (CAFs) play predominant roles in shaping a pro-metastatic tumor microenvironment. The present study demonstrated that SLIT2, an axon guidance protein, produced by CAFs and promoted gastric cancer (GC) metastasis in two gastric cancer cell lines (AGS and MKN45) by binding to roundabout guidance receptor 1 (ROBO1). Mass-spectrometry analysis revealed that ROBO1 could interact with NEK9, a serine/threonine kinase. And their mutual binding activities were further enhanced by SLIT2. Domain analysis revealed the kinase domain of NEK9 was critical in its interaction with the intracellular domain (ICD) of ROBO1, and it also directly phosphorylated tripartite motif containing 28 (TRIM28) and cortactin (CTTN) in AGS and MKN45 cells. TRIM28 function as a transcriptional elongation factor, which directly facilitate CTTN activation. In addition, Bioinformatics analysis and experimental validation identified transcriptional regulation of STAT3 and NF-κB p100 by TRIM28, and a synergetic transcription of CTTN by STAT3 and NF-κB p100 was also observed in AGS and MKN45. Therefore, CAF-derived SLIT2 increased the expression and phosphorylation levels of CTTN, which induced cytoskeletal reorganization and GC cells metastasis. A simultaneous increase in the expression levels of NEK9, TRIM28 and CTTN was found in metastatic GC lesions compared with paired non-cancerous tissues and primary cancer lesions via IHC and Multiplex IHC. The analysis of the data from a cohort of patients with GC revealed that increased levels of NEK9, TRIM28 and CTTN were associated with a decreased overall survival rate. On the whole, these findings revealed the connections of CAFs and cancer cells through SLIT2/ROBO1 and inflammatory signaling, and the key molecules involved in this process may serve as potential biomarkers and therapeutic targets for GC.

The prognostic effect of immune cell infiltration depends on molecular subtype in Endometrioid Ovarian Carcinomas.

Endometrioid ovarian carcinoma (ENOC) is the second most-common type of ovarian carcinoma, comprising 10-20% of cases. Recently, the study of ENOC has benefitted from comparisons to endometrial carcinomas (EC) including defining ENOC with four prognostic molecular subtypes. Each subtype suggests differential mechanisms of progression, though tumor initiating events remain elusive. There is evidence that the ovarian microenvironment may be critical to early lesion establishment and progression. However, while immune infiltrates have been well studied in high-grade serous ovarian carcinoma, studies in ENOC are limited. We report on 210 ENOC, with clinical follow-up and molecular subtype annotation. Using multiplex immunohistochemistry and immunofluorescence, we examine the prevalence of T cell lineage, B cell lineage, macrophages, and populations with PD-1 or PD-L1 across subtypes of ENOC. Immune cell infiltrates in tumor epithelium and stroma showed higher densities in ENOC subtypes with known high mutation burden (POLEmut and MMRd). While molecular subtypes were prognostically significant, immune infiltrates were not (OS p>0.2). Analysis by molecular subtype revealed that immune cell density was prognostically significant in only the no specific molecular subtype (NSMP) subtype, where immune infiltrates lacking B cells (TILB minus) had inferior outcome (DSS HR:4.0 CI 1.1-14.7, p<0.05). Similar to EC, molecular subtype stratification was generally superior to immune response in predicting outcomes. Subtype stratification is critical for better understanding of ENOC, in particular the distribution and prognostic significance of immune cell infiltrates. The role of B cells in the immune response within NSMP tumors warrants further study.

ATRT-18. ELUCIDATING THE ETMR MICROENVIRONMENT USING SPATIAL MULTI-OMICS TECHNOLOGIES

Abstract Embryonal tumor with multilayered rosettes (ETMR) is a highly aggressive CNS neoplasm that occurs almost exclusively in infants under 4 years of age and is associated with an extremely poor prognosis. A bottleneck in the development of new and curative treatments for ETMR stems from our limited understanding of the spatiotemporal biological heterogeneity within patient tumor samples and a lack of preclinical models that adequately reflect the entire biological spectrum. Novel lipid-based therapeutics that encompass ganglioside-directed immunotherapy, targeting lipid metabolism and membrane lipid therapy, have shown efficacy in the treatment of brain tumors but have yet to be evaluated in the treatment of ETMR. We carried out mass spectrometry imaging on ETMR patient samples to identify the histology-specific accumulation of lipids within the diverse cell populations of the tumor microenvironment. Our preliminary studies identified the accumulation of glycosphingolipids, cardiolipins, phosphatidylinositols, and ceramide-1-phosphates within tumor cells, including the characteristic multilayered rosettes, and within different microvascular proliferations. All data were correlated to histopathology and Ki67 proliferation index. We next evaluated the lipid profiles in the patient-derived ETMR cell line, BT183, compared to control neural stem cells (NSCs), grown as 3D tumorspheres and neurospheres, respectively. From this data we identified lipids that accumulated in our patient samples and the ETMR cell line but were significantly reduced or not detected in the control NSCs. Analysis aimed at a systems biology approach to study the ETMR microenvironment using imaging mass cytometry for multiplex IHC and spatial transcriptomics to correlate lipidomic phenotype to distinct cell populations within the microenvironment are ongoing. Preclinical model development based on these findings and drug screening of therapeutics targeting these lipidomic pathways are also ongoing.

ETCTN/NCI 10330: A phase 2 study of belinostat with SGI-110 (guadecitabine) or ASTX727 (decitabine/cedazuridine) for the treatment of unresectable and metastatic conventional chondrosarcoma.

11531 Background: Conventional chondrosarcoma (cCS) is the 2nd most common primary bone tumor and is resistant to chemotherapy and radiation. IDH1/2 mutations (m) occur in 50% of cCS. Both IDHm and wild-type (wt) cCS harbor epigenetic dysregulation. In preclinical models of IDHm and wt cCS, combination treatment with HDAC and DNMT inhibitors (i) suppressed growth in vitro and in vivo by reversing the hypermethylated state and inducing tumor suppressors, interferon response genes and apoptosis (Sheikh T, Schwartz G. Mol Cancer Ther 2021;20). Methods: NCI 10330 is a single-arm, multicenter, phase 2 study evaluating the HDACi belinostat (B) with the DNMTi SGI-110 (S) or ASTX727 (A). A replaced S due to drug availability (pts were replaced). Pts had advanced cCS, ECOG PS ≤ 2 and could be treatment naïve. Progression was required for grade 1 cCS. Pts received B 1000mg/m2 IV + S 45mg/m2 SC both days 1-5 or B (same dosing) + A (cedazuridine 100mg/decitabine 35mg) PO both days 1-5, in 28-day cycles. 1° endpoint was objective response. A Simon 2-stage design was used. If ≥ 2/13 responses occurred in stage 1, the study would proceed to full accrual. Design had 85% power with α = 0.05 to test ORR 8% vs 28%. 2° endpoints included safety, PFS and OS. A safety lead-in was performed. Paired biopsies were collected. Results: Stage 1 is complete. 19 pts were treated: 6 on B+S and 13 on B+A. Median age was 50 and 67 years, respectively. All pts had prior surgery. 17% (B+S) and 38% (B+A) had prior radiation. 33% (B+S) and 55% (B+A) were IDHm. 67% (B+S) and 75% (B+A) were histologic grade ≥ 2. There were no objective responses. Best response (at 8 weeks) was stable disease (SD) in 4/6 pts (67%) on B+S and 6/10 pts (60%) on B+A. mPFS was 4.2 mos (95% CI 1.97-NR) for B+S and 3.8 mos (95% CI 2.17-NR) for B+A. mOS has not been reached. For B+A, mPFS for IDHm vs wt pts was 4.7 and 3.1 mos, respectively (p=0.21). One pt with IDHm grade 2 cCS who progressed on FT-2102 (IDH1i) remains on B+A &gt; 1 year. There were no DLTs during either safety lead-in. Grade 3/4 treatment-related adverse events (TRAEs) occurred in 17% (B+S) and 69% (B+A). For B+A, the most common grade 3/4 TRAE was neutropenia (54%) and the most common all-grade TRAEs were nausea (69%), leukopenia (61%), neutropenia (54%), anemia (46%) and fatigue (46%). Paired tumor biopsies are being evaluated with whole exome sequencing, RNAseq, methylation array and multiplex IHC with results forthcoming. Conclusions: Combination HDACi + DNMTi was well-tolerated in advanced cCS. There were no objective responses; however, a subset of pts experienced prolonged SD with a trend towards improved mPFS in IDHm pts. Correlative work is ongoing with a focus on differential effects on IDHm tumors and whether modulation of the immune microenvironment might support combinations with immunotherapy. Support: UM1CA186689. Clinical trial information: NCT04340843 .

Neutrophil-to-lymphocyte ratio as a predictor of immune checkpoint inhibitor therapy response in advanced bladder cancer.

e16586 Background: Immune checkpoint inhibitor (ICI) therapy is a novel and promising agent for treating muscle invasive bladder cancer (MIBC). However, there is a need for further understanding of which patient factors or biological markers can be used to help identify patients who will have a successful response to ICI therapy. We hypothesized that Neutrophil-to-Lymphocyte Ratio (NLR) could be predictive of response to ICI therapy as this ratio has previously been reported to correlate with a higher number of myeloid derived suppressor cells. Methods: A retrospective cohort analysis was performed on patients with advanced or metastatic bladder cancer who were treated with ICI therapy at a single institution between 2015-2020. Information on survival, disease recurrence, and patient characteristics was gathered. Neutrophil and lymphocyte numbers were recorded at time of ICI administration and a ratio of neutrophils to lymphocytes was calculated. The median of these values was calculated and used to divide the cohort into low NLR and high NLR. Tissue samples from a subset of these patients were collected and sent for multiplex immunohistochemistry with a myeloid and T cell staining panel. Results: In a cohort of 115 patients with advanced bladder cancer treated with ICI, the mean time to last follow up or event (death or disease progression) was 375.78 days (SD 41). 35 patients (30%) had either a complete or partial response to ICI therapy. A Kaplan Meier survival analysis shows a significant difference in survival between the low and high NLR group, with lower NLR having a longer event free survival (Wilcoxon rank p = 0.0156). Multiplex IHC showed variable tumor and adjacent microenvironmental distributions of myeloid and lymphoid marker positive populations in ICI responders and non-responders. Conclusions: In an effort to better predict which patients may benefit from ICI therapy, we have studied NLR at the time of ICI administration and its association with event free survival. Our results suggest that a lower NLR could be associated with a longer event free survival. Further research is being conducted to study the immune microenvironment as it relates to bladder cancer response to ICI therapy.

High-throughput proteomics profiling-derived signature associated with chemotherapy response and survival for stage II/III colorectal cancer

Adjuvant chemotherapy (ACT) is usually used to reduce the risk of disease relapse and improve survival for stage II/III colorectal cancer (CRC). However, only a subset of patients could benefit from ACT. Thus, there is an urgent need to identify improved biomarkers to predict survival and stratify patients to refine the selection of ACT. We used high-throughput proteomics to analyze tumor and adjacent normal tissues of stage II/III CRC patients with /without relapse to identify potential markers for predicting prognosis and benefit from ACT. The machine learning approach was applied to identify relapse-specific markers. Then the artificial intelligence (AI)-assisted multiplex IHC was performed to validate the prognostic value of the relapse-specific markers and construct a proteomic-derived classifier for stage II/III CRC using 3 markers, including FHL3, GGA1, TGFBI. The proteomics profiling-derived signature for stage II/III CRC (PS) not only shows good accuracy to classify patients into high and low risk of relapse and mortality in all three cohorts, but also works independently of clinicopathologic features. ACT was associated with improved disease-free survival (DFS) and overall survival (OS) in stage II (pN0) patients with high PS and pN2 patients with high PS. This study demonstrated the clinical significance of proteomic features, which serve as a valuable source for potential biomarkers. The PS classifier provides prognostic value for identifying patients at high risk of relapse and mortality and optimizes individualized treatment strategy by detecting patients who may benefit from ACT for survival.

Regional Variation in the Tumor Microenvironment, Immune Escape and Prognostic Factors in Breast Cancer in Sub-Saharan Africa.

The low overall survival rates of patients with breast cancer in sub-Saharan Africa (SSA) are driven by regionally differing tumor biology, advanced tumor stages at diagnosis, and limited access to therapy. However, it is not known whether regional differences in the composition of the tumor microenvironment (TME) exist and affect patients' prognosis. In this international, multicentre cohort study, 1,237 formalin-fixed, paraffin-embedded breast cancer samples, including samples of the "African Breast Cancer-Disparities in Outcomes (ABC-DO) Study," were analyzed. The immune cell phenotypes, their spatial distribution in the TME, and immune escape mechanisms of breast cancer samples from SSA and Germany (n = 117) were investigated using histomorphology, conventional and multiplex IHC, and RNA expression analysis. The data revealed no regional differences in the number of tumor-infiltrating lymphocytes (TIL) in the 1,237 SSA breast cancer samples, while the distribution of TILs in different breast cancer IHC subtypes showed regional diversity, particularly when compared with German samples. Higher TIL densities were associated with better survival in the SSA cohort (n = 400), but regional differences concerning the predictive value of TILs existed. High numbers of CD163+ macrophages and CD3+CD8+ T cells accompanied by reduced cytotoxicity, altered IL10 and IFNγ levels and downregulation of MHC class I components were predominantly detected in breast cancer samples from Western SSA. Features of nonimmunogenic breast cancer phenotypes were associated with reduced patient survival (n = 131). We therefore conclude that regional diversity in the distribution of breast cancer subtypes, TME composition, and immune escape mechanisms should be considered for therapy decisions in SSA and the design of personalized therapies. See related Spotlight by Bergin et al., p. 705.

Abstract 6775: Combination of spatial transcriptomics and multiplex IHC as valuable multi-omics tool for biomarker discovery

Abstract Colorectal cancer (CRC) is one of the most common cancers worldwide and shows heterogenous molecular subtypes making personalized medicine as well as identifying new targets highly important to provide individual patients with the most appropriate treatment. To gain more insight into the visualization of potential molecules or pathways for targeting CRC we used a multi-omics approach for the simultaneous analysis of gene and protein expression within a sample. In this study we combined fluorescent multiplex immunohistochemistry (mIHC) for the detection of proteins (4-plex panel) with the Visium Spatial Transcriptomics technology (10x Genomics) that enables the detection of the whole transcriptome in the histological context. A formalin-fixed paraffin-embedded (FFPE) tumor tissue sample from a patient diagnosed with CRC was selected according to our quality standards. For this multi-omics approach, serial sections were prepared. The first section was used for fluorescent mIHC staining visualizing the protein expression of Ki67 (proliferation marker), p53 and p21 (both tumor suppressor genes). The second section was stained for hematoxylin and eosin (H&amp;E) to evaluate the tissue morphology. On the third section the Visium FFPE Spatial Gene Expression workflow was applied, and gene expression patterns were analyzed by using the software Space Ranger and Loupe Browser. Our data showed on the one hand a good correlation of protein and gene expression of Ki67, p53 and p21 within the analyzed sample and on the other hand a clear difference of expression patterns between tumor cell areas and regions with corresponding normal mucosa cells. Moreover, by comparing Spatial Transcriptomics gene expression patterns of tumor cell and corresponding normal mucosa cell areas, we also identified genes that were linked to other cancer types and/or are still only poorly described in cancer, especially for CRC. Corresponding protein expression will be verified by chromogenic IHC in the next steps. The combination of fluorescent mIHC and Spatial Transcriptomics has been shown to be a valuable approach not only to visualize already described relations as proof of principle, but more importantly to enable the discovery of new biomarkers or pathways predominantly linked to colorectal tumor tissue that may serve as new targets for cancer treatment. Citation Format: Nicole Kerstedt, Monika Schoeppler, Bita Motamedi-Baniassad, Antonia Hirt, Julia Ploetzky, Mirja Kastein, Laura Thoms, Malik Khenkhar, Hartmut Juhl, Kerstin A. David. Combination of spatial transcriptomics and multiplex IHC as valuable multi-omics tool for biomarker discovery. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6775.

Abstract 6780: Characterization of immunological heterogeneity in the tumor microenvironment by integrated analyses using single cell RNAseq, spatial RNAseq and multiplex IHC

Abstract Heterogeneity in resistant to immunotherapies of tumor microenvironment (TME) has been implicated in immunotherapies to cause immune evasion or drug resistance. This study was conducted to explore the heterogeneity of TME through multiplex IHC, spatial and RNA sequencing analysis. We selected a sample from a lung adenocarcinoma patient without EGFR-activating mutation and expressing 30% of PD-L1. For quantitative analysis by multiplex IHC, various markers including CD4, CD8, FoxP3, granzyme B, CD20 and pan-cytokeratin were stained with 7 different fluorescence dyes, which was imaged with Vectra Polaris (Akoya). For scRNAseq and spatial RNAseq, we used 5’ chromium library kit (10X Genomics) to make library construction. Integrated raw data was generated using Cell ranger, Seurat pipeline and Azimuth package. The tumor area was divided into 16 clusters in which we selected 2 clusters based on CD3/45 expression. There was a noticeable distinction between the two clusters which were defined as the ‘High’ region (CD45highCD3high cluster) and the ‘Low’ region (CD45lowCD3low cluster). By multiplex IHC, percentage of CD8+T cells was higher in the ‘High’ region than in the ‘Low’ region (8.5% vs. 0.8%, respectively). Subsequent analysis of two clusters using spatial and single cell RNA seq, the ‘Low’ region was characterized by increased hypoxia-associated gene expressions including HIF1A, HIF3A and VEGFA. Various immune cells were abundant in the ‘High’ region and CD45 expression level was 11-fold higher in the ‘High’ region compared to the ‘Low’ region. Cytokine/chemokine network analysis via spatial RNAseq revealed that gene expression of tumor necrosis factor (TNF) family-associated factors increased in the 'High' region compared to the ‘Low’ region (TNF, FAS, TRAIL, RANKL and CD40), which is well-known to promotes apoptosis, programmed cell death, or necrosis of certain cancer. Additionally, the ‘High’ region also had elevated levels of the PD-1/PD-L1, CD155, CD122/TIGIT, Siglec10/CD24, LAG3/LAGLS3, and CD47/CD172a axes, suggesting active immune responses. Intriguingly, combined analyses showed that ‘High’ region showed enhanced level of CD44 expression as the leading-edged gene, which suggests the metastatic potential of tumor cells. Furthermore, scRNA analysis confirmed that CD44 expression was mainly higher in macrophages, suggesting that tumor-associated macrophages partially affected tumor cell metastasis in the ‘High’ region. Our finding suggests that understanding the intratumoral immunological heterogeneity of lung adenocarcinoma can help to study the mechanism of tumor heterogeneity by integrated spatial RNAseq and scRNAseq analyses. This type of technique could be applied to understand complex networks of anti-tumor immune activities, drug resistance mechanisms and immunotherapeutic response of cancer. Citation Format: Seul Lee, Jae-Hwan Kim, Kwangmin Na, Seung Min Yang, Dong Kwon Kim, Sujeong Baek, Seong-san Kang, Yu Jin Han, Chun-Bong Synn, Mi hyun Kim, Heekyung Han, Young Taek Kim, Sungwoo Lee, Youngseon Byeon, Young Seob Kim, Ji Yun Lee, Jii Bum Lee, Chang Gon Kim, Min Hee Hong, Sun Min Lim, Kyoung-Ho Pyo, Byoung Chul Cho. Characterization of immunological heterogeneity in the tumor microenvironment by integrated analyses using single cell RNAseq, spatial RNAseq and multiplex IHC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6780.

Abstract 2108: High prevalence of immune exclusion in cancer as determined by pathologist assessment and image analysis

Abstract Background: Immune infiltrated tumors have high levels of lymphocytes contacting tumor cells and are more responsive to checkpoint inhibitors. Tumors with few lymphocytes in contact with tumor cells can be divided into desert or excluded phenotypes based on lymphocyte absence/paucity or restriction to the peritumoral stroma, respectively. Standard methods to systematically identify and characterize immune exclusion for patient stratification are lacking. Methods: Slides from colorectal (CRC), non-small cell lung (NSCLC), ovarian (OC), pancreatic (PDAC), and triple-negative breast cancers (TNBC), and leiomyosarcoma (LMS) and undifferentiated pleomorphic sarcoma (UPS) were stained with multiplex IHC (mIHC) for CD8 and panCK. Pathologist assessment (PA) was done to classify the tumors as: desert, with a paucity of CD8 T cells; excluded, with CD8 T cells not penetrating the tumor parenchyma; and infiltrated, with CD8 T cells within the tumor parenchyma. For the carcinomas, adjacent sections were stained with a multiplex immunofluorescence (mIF) panel containing CD8 and a tumor cell marker. Image analysis (IA) was performed on the mIF images to quantify CD8 cell density in the tumor parenchyma and stroma to categorize immune phenotypes. Results: Immune phenotypes were classified for 143 samples based on PA of mIHC images and 103 samples by IA of mIF images (see Table 1). Immune exclusion as determined by both PA and IA was highest in CRC, PDAC, and TNBC. IA differed from PA in 25 (24.3%) cases. Pathologist review of the discordant cases revealed discrepancies were generally due to tumor heterogeneity, thresholding, assessment of cells at the tumor-stroma boundaries, necrosis, and artifacts. Conclusion: Immune exclusion is highly prevalent in the examined carcinoma types. IA-based approaches, guided by pathologist input, offer promise to quantitatively determine tumor immune phenotypes in a quick and systematic way to guide patients to the most effective therapy. Table 1. Pathologist Assessment Classification Image Analysis Classification Tumor Type n Desert (%) Excluded (%) Infiltrated % Desert (%) Excluded (%) Infiltrated % CRC 20 3 (15.0) 14 (70.0) 3 (15.0) 6 (30.0) 11 (55.0) 3 (15.0) NSCLC 21 6 (28.6) 12 (57.1) 3 (14.3) 6 (28.6) 9 (42.9) 6 (28.6) OC 20 3 (15.0) 9 (45.0) 8 (40.0) 9 (45.0) 3 (15.0) 8 (40.0) PDAC 21 6 (28.6) 14 (66.7) 1 (4.8) 7 (33.3) 12 (57.1) 2 (9.5) TNBC 21 3 (14.3) 15 (71.4) 3 (14.3) 4 (19.0) 10 (47.6) 7 (33.3) LMS 20 3 (15.0) 1 (5.0) 16 (80.0) NA NA NA UPS 20 4 (20.0) 1 (5.0) 15 (75.0) NA NA NA Total 143/103 28 (19.6) 66 (46.2) 49 (34.3) 32 (31.1) 45 (43.7) 26 (25.2) Citation Format: Florent Peyraud, Fredrick D. Gootkind, Antoine Italiano, Alban Bessede, Jean-Philippe Guegan, Xinwei Sher, Thomas Schürpf, Guy T. Clifton, Laura A. Dillon. High prevalence of immune exclusion in cancer as determined by pathologist assessment and image analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2108.

Abstract 6433: A novel bacterial strain, CJRB-101, induces anti-cancer effects by repolarization of M2 to CXCL9 and CXCL10 dual expressing M1 macrophages in humanized non-small cell lung cancer mice models

Abstract Backgrounds: Live biotherapeutic products (LBPs) emerged as potential therapeutics to overcome the limitation of ICIs. This research shows that CJRB-101, a novel bacterial strain, can improve anti-tumor effects in synergy with pembrolizumab in non-small cell lung cancer (NSCLC). Objectives and Methods: Tumors from NSCLC patients (anti-PD-1 refractory and resistant) were transplanted into Hu-CD34-NSG to establish humanized patient-derived xenograft (PDX) mice models. Five models (YHIM-2003, 2004, 2009, 2010 and 2014) were treated with CJRB-101 at low (5 × 107 CFU) or high (109 CFU) doses, or with pembrolizumab (10 mg/kg, i.p., Q5D) or in combination. Tumor growth inhibition (TGI) rate was measured. Tumor microenvironment (TME) was analyzed using multiplex IHC, flow cytometry and single cell RNA sequencing. Ex-vivo assays were performed to validate in silico findings. Results: Tumor in PDX models was unresponsive to pembrolizumab alone, however, in combination with CJRB-101 effectively suppressed tumor growth. The synergy was highlighted in YHIM-2009 where TGI was 10-fold higher (56%) than pembrolizumab group (5%). Immune profiling revealed that macrophages may be responsible for the anti-tumor effects of CJRB-101. IHC showed significantly increased antigen presenting specialized DCs (CD16+CD68−CD11c+) and granzyme B+ CD8+ T cells in the tumor by CJRB-101 compared to pembrolizumab (p&amp;lt;0.01). This suggested that CJRB-101 induced infiltration of cytotoxic CD8 T cells into the tumor nest by enhancing antigen presenting machinery. Trajectory analysis showed that CJRB-101 induced repolarization of M2 to M1 macrophages, characterized by high expression of CXCL9/10. CXCL9+/10+ M1 macrophages were comparatively more abundant in the combination group (23.11%) than the pembrolizumab group (0.91%). CXCL9/CXCL10 expression in macrophages was higher in the CJRB-101 group compared to the pembrolizumab group (p&amp;lt;0.0001). The combination group (10.84%) had a higher relative abundance of CD8+ T cells compared to the pembrolizumab group (1.58%) and higher IFNγ expression in CD8+ T cells compared to the pembrolizumab group (p=0.0152), suggesting that CJRB-101 repolarized macrophages and recruited active CD8+ T cells. Co-culture assays using bone marrow-derived macrophages validated that CJRB-101 drove differentiation towards F4/80+ or MHC II+ expressing M1 macrophage (p&amp;lt;0.0001) and repolarized existing M2 (CD206+) to M1 (p=0.0002). Conclusion: Combination treatment of CJRB-101 with anti-PD-1 showed synergistic anti-tumor effects via repolarization of M2 to M1 macrophages, leading to activation of CD8+ T cells in TME. Especially, CXCL9+/10+ M1 macrophage playing a key role in TGI induced by CJRB-101 in NSCLC models. Findings from this study provided rationale for clinical investigation of CJRB-101. Citation Format: Arim Min, Chun-bong Synn, Seong-san Kang, Bo-eun Kwon, Junwon Yang, Hyunkyung Park, Jieun Im, Hyunjeong Kim, Sujeong Beak, Dong Kwon Kim, Jii Bum Lee, Hyeonseok Oh, Seung Min Yang, Yu Jin Han, Mi hyun Kim, Heekyung Han, Kwangmin Na, Young Taek Kim, Sungwoo Lee, Mi Ran Yun, Jae Hwan Kim, Youngseon Byeon, Young Seob Kim, Ji Yun Lee, Chang Gon Kim, Min Hee Hong, Sun Min Lim, Kyoung-Ho Pyo, Byoung Chul Cho. A novel bacterial strain, CJRB-101, induces anti-cancer effects by repolarization of M2 to CXCL9 and CXCL10 dual expressing M1 macrophages in humanized non-small cell lung cancer mice models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6433.

Abstract 5499: Synergistic effects of the combination of ERK1/2 with EGFR, KRASG12C, CDK4/6, and PD-L1 inhibition for cancer treatment

Abstract Background: Mitogen-activated protein kinase (MAPK) cascade is a key pathway that regulates a wide variety of cellular processes, which is frequently activated in cancers. Many nods of the MAPK pathway are considered as promising anti-tumor drug targets, such as RTKs, KRASG12C, RAF, MEK1/2, and ERK1/2. Multiple inhibitors targeting proteins on MAPK pathway have been developed for cancer treatment. However, the effectiveness of these inhibitors is often limited due to acquired drug resistance via pathway feedback activation, indicating the necessity of combination strategies to help block reactivation or bypass activation of MAPK pathway. ATG-017 is an oral, potent, and highly selective inhibitor of ERK1/2, which is under Phase 1 clinical investigation. This study tested the in vivo antitumor effects induced by the combination of ATG-017, with EGFR inhibitor (Osimertinib), KRASG12C inhibitor (ATG-012), CDK4/6 inhibitor (Abemaciclib) or PD-L1 inhibitor (Atezolizumab), in preclinical tumor models. Methods: The in vivo combinations of the drugs were tested in NCI-H1975, NCI-H358 (non-small cell lung cancer) or EL4 (T cell Lymphoma) CDX mouse models. The tumor bearing mouse were treated with vehicle control, ATG-017 (15 or 25 mg/kg, QD), Osimertinib (1mg/kg, QD), ATG-012 (10mg/kg, QD), Abemaciclib (25mg/kg, QD), Atezolizumab (10mg/kg, BIW) or the combination for 9 to 21 days. The tumor size was measured twice a week and tumor growth inhibition (TGI) was evaluated compared with vehicle group. Tumor tissues were collected for tumor infiltrating lymphocyte (TIL) analysis using Flow cytometry or multiplex IHC. Results: In the NCI-H1975 CDX in vivo study, the monotherapy of ATG-017 and Osimertinib induced TGIs of 61.95% and 79.18%, respectively on day 17 after grouping. The combination of ATG-017 and Osimertinib showed 101.85% TGI. In the NCI-H358 CDX in vivo study, the monotherapy of ATG-017, ATG-012, and combination induced TGI of 44.29%,73.71% and 97.13%, respectively on day 8 after grouping. The monotherapy of ATG-017, Abemaciclib, and the combination induced TGIs of 91.40%,63.10% and 108.15%, respectively on day 20 after grouping. In the EL4 syngeneic T cell lymphoma model, neither ATG-017 nor Atezolizumab showed single agent activity, while the combination induced a significant TGI of 21.86% on day 9 after grouping. The percentage of infiltrating CD8+ T cells, CD8:CD4 ratio and M1:M2 macrophage ratio were found increased in the combination group, suggesting the potential role of ATG-017 plus PD-L1 inhibitor in changing a “cold” tumor towards a “hot” phenotype. Conclusion: Strong synergism has been observed for the combination of ATG-017 with EGFR, KRASG12C, CDK4/6, and PD-L1 inhibition, suggesting promising therapeutic strategies for cancer patients that warrants further investigation. Citation Format: Ya Kong, Peng Chen, Lulu Jiang, Bin Jiang, Jay Mei, Bo Shan, Bing Hou. Synergistic effects of the combination of ERK1/2 with EGFR, KRASG12C, CDK4/6, and PD-L1 inhibition for cancer treatment. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5499.

Abstract 5788: Single-cell and spatial transcriptomic mapping of human renal cell carcinoma brain metastases uncovers actionable immune-resistance targets

Abstract Introduction: The discovery of immune checkpoint inhibitors has revolutionized metastatic renal cell carcinoma (RCC) treatment. However, in patients with RCC brain metastases, response rates are low and survival outcomes poor. To understand the tumor microenvironmental differences between primary kidney tumors, extracranial metastases, and brain metastases, we developed a detailed single-cell atlas of RCC brain metastases along with their matched extracranial and primary tumors. Methods: We performed single-nucleus RNA-seq on 27 samples (nearly 200,000 cells) from RCC patients; samples included 14 brain metastases, 8 matched primary kidney tumors, and 5 matched extracranial metastases. We performed multiplex IHC to validate selected transcriptomic findings. We used Nanostring CosMx 960-plex RNA spatial molecular imaging technique on selected samples to validate cellular interactions in a spatial context. Results: We established a multi-tissue single-cell atlas of RCC brain metastases by identifying 9 major and 37 minor malignant, immune, and stromal cell clusters. Brain metastases had higher neuronal and glial cells interacting with immune and tumor cells. Brain metastasis tumor cells were also transcriptomically reprogrammed to adapt to the brain microenvironment through enrichment of MYC targets, MTORC1 signaling, epithelial-mesenchymal transition, fatty-acid metabolism, oxidative phosphorylation, and reactive oxygen species pathways. Moreover, cell-to-cell communication and downstream target gene expression analyses showed that brain metastasis tumor cells expressed ligands and receptors that induce tumor cell proliferation in both autocrine and paracrine fashions. Among T-cell populations, we found fewer proliferating cytotoxic T lymphocytes in the brain than in other sites. Moreover, T cells in brain metastases expressed higher levels of several targetable inhibitory checkpoints than did extracranial metastases. In addition, we found that naïve/memory T cells in brain metastases were a favorable prognostic marker for overall survival after craniotomy. Our characterization of myeloid cell populations across the 3 disease sites found fewer dendritic cells and monocytes in the brain compared to other sites. Macrophages in brain metastases more highly expressed an M2 immunosuppressive gene signature than did those in primary RCC tumors. Conclusion: Our findings from the largest single-cell atlas of RCC brain metastases with matched primary and extracranial metastases suggest several unique targetable, immunosuppressive biological mechanisms in the brain microenvironment. These results provide a foundation for a deeper understanding of RCC brain metastasis biology and can serve as a resource for the scientific community to further explore therapeutically targetable tumor and immune-related mechanisms. Citation Format: Elshad Hasanov, Truong Nguyen Anh Lam, Jerome Lin, Patrick K. Reville, Merve Hasanov, Anna K. Casasent, David Shih, Sahin Hanalioglu, Mehmet Asim Bilen, Omar Alhalabi, Berrin Babaoglu, Baylar Baylarov, Adeboye O. Osunkoya, Lisa M. Norberg, Joy Gumin, Tuan M. Tran, Jianzhuo Li, Anh G. Hoang, Haidee D. Chancoco, Brittany C. Parker Kerrigan, Erika J. Thompson, Betty YS Kim, Dima Suki, Melike Mut, Figen Soylemezoglu, Giannicola Genovese, Kadir C. Akdemir, Hussain A. Tawbi, Nizar M. Tannir, Florencia McAllister, Michael A. Davies, Padmanee Sharma, Jason Huse, Frederick Lang, Nicholas Navin, Eric Jonasch. Single-cell and spatial transcriptomic mapping of human renal cell carcinoma brain metastases uncovers actionable immune-resistance targets [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5788.

Abstract 4631: Multiplex IHC assay to explore regional heterogeneity of FAP and inflammatory cell density in localized prostatic adenocarcinoma

Abstract Cancer-associated fibroblasts (CAFs) expressing FAP promote tumor growth, invasion and immune suppression. FAP is a molecular imaging target in cancer and its protease activity is a potential anti-cancer drug target. While FAP expression was associated with biochemical recurrence after prostatectomy using tissue microarrays (TMAs)(DOI:10.1158/2767-9764.CRC-21-0183), its expression has not been comprehensively correlated with morphological features of disease aggressiveness beyond grade. 48 cases of localized prostatic adenocarcinoma were used for a multiplex immunohistochemical assay that included FAP, CD45, CD163, p63 and Keratin 8. Each of these markers were individually optimized by single-plex staining and were then performed as an iterative IHC assay (PMID:35188986) and quantification was performed using the HALO image analysis platform (Indica Labs). We developed a second multiplex assay including FAP, vimentin, smooth muscle actin, desmin, CD31, S100, keratin 8 and p63. FAP IHC staining was analytically validated using a series of positive and negative cell lines. In normal appearing (non-inflamed) prostate regions, FAP expression was negative. By contrast, upregulation of FAP was observed in the stromal compartment in regions of chronic inflammation and some proliferative inflammatory atrophy (PIA) lesions. In tumor regions, only 1 case was totally negative for FAP. Except for 2 cases, in which there was focal weak tumor cell staining, all FAP expression was present in the tumor stromal compartment (TSC). The vast majority of FAP expression was associated with Vim+/Des- fibroblasts, which at times were also positive for SMA (Vim+/Des-/SMA+), indicating they are myofibroblasts. There was very infrequent FAP expression associated with M2 macrophages, endothelial cells, nerves and vimentin-negative smooth muscle cells, indicating that the majority of FAP expression occurs in fibroblasts. Preliminary quantitative data using visual estimations of the fraction of TSC expressing FAP (range, 0-80%, mean=35.8%, median=30%, SD=23.7) was not associated with the overall GS/grade group, but was associated with non-organ confined disease. Furthermore, there was a trend towards increased FAP expression in cases showing intraductal carcinoma and large cribriform formation. Ongoing studies are in process to obtain quantitative data by image analysis and to correlate FAP expression with the presence of overall inflammatory cell density and the density of M2 macrophages. Additionally, we will characterize the cases in terms of molecular features including TMPRSS2-ERG status and PTEN genomic status. Future use of these panels will facilitate studies of associations of FAP with clinical outcome, MRI and PET imaging, response to specific treatments and to help characterize FAP as a predictor of response to emerging FAP inhibitors and FAP-targeted prodrugs. Citation Format: Fernanda Caramella Pereira, Alan K. Meeker, Kenneth Pienta, Qizhi Zheng, Tracy Jones, Srinivasan Yegnasubramanian, Jessica L. Hicks, Sujayita Roy, Angelo M. De Marzo, W. Nathaniel Brennen. Multiplex IHC assay to explore regional heterogeneity of FAP and inflammatory cell density in localized prostatic adenocarcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4631.