Spatially resolved transcriptomics reveal the determinants of primary resistance to immunotherapy in NSCLC with mature tertiary lymphoid structures

空间分辨转录组学揭示了具有成熟三级淋巴结构的 NSCLC 对免疫治疗产生原发性耐药性的决定因素

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作者:Florent Peyraud, Jean-Philippe Guégan, Christophe Rey, Oren Lara, Ophélie Odin, Marie Del Castillo, Lucile Vanhersecke, Jean-Michel Coindre, Emma Clot, Maxime Brunet, Thomas Grellety, Angélique Tasseel, Sylvestre Le Moulec, Robert J Johnston, Alban Bessede, Antoine Italiano0

Abstract

Effectiveness of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC) has been linked to the presence of mature tertiary lymphoid structures (mTLSs) within the tumor microenvironment (TME). However, only a subset of mTLS-positive NSCLC derives benefit, thus highlighting the need to unravel ICI response determinants. The comprehensive analysis of ICI-treated patients with NSCLC (n = 509) from the Bergonié Institute Profiling (BIP) study (NCT02534649) reveals that the presence of mTLSs correlates with improved clinical outcomes, independently of programmed death ligand 1 (PD-L1) expression and genomic features. Employing spatial transcriptomics alongside multiplex immunofluorescence (mIF), we show that two distinct subsets of cancer-associated fibroblasts (CAFs) are essential factors in mediating primary resistance to ICIs in mTLS-positive NSCLC. These CAFs are associated with immune exclusion, CD8+ T cell exhaustion, and increased regulatory CD4+ T cell infiltration, underscoring an immunosuppressive TME. Our study highlights the pivotal role of specific CAF subsets in thwarting ICIs, proposing new therapeutic targets to enhance immunotherapy efficacy.

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