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Diversity of the immune microenvironment and response to checkpoint inhibitor immunotherapy in mucosal melanoma
Joris L. Vos, … , Christian U. Blank, Charlotte L. Zuur
Joris L. Vos, … , Christian U. Blank, Charlotte L. Zuur
Published November 8, 2024
Citation Information: JCI Insight. 2024;9(21):e179982. https://doi.org/10.1172/jci.insight.179982.
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Research Article Immunology Oncology

Diversity of the immune microenvironment and response to checkpoint inhibitor immunotherapy in mucosal melanoma

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Abstract

Mucosal melanoma (MucM) is a rare cancer with a poor prognosis and low response rate to immune checkpoint inhibition (ICI) compared with cutaneous melanoma (CM). To explore the immune microenvironment and potential drivers of MucM’s relative resistance to ICI drugs, we characterized 101 MucM tumors (43 head and neck [H&N], 31 female urogenital, 13 male urogenital, 11 anorectal, and 3 other gastrointestinal) using bulk RNA-Seq and immunofluorescence. RNA-Seq data show that MucM has a significantly lower IFN-γ signature levels than CM. MucM tumors of the H&N region show a significantly greater abundance of CD8+ T cells, cytotoxic cells, and higher IFN-γ signature levels than MucM from lower body sites. In the subcohort of 35 patients with MucM treated with ICI, hierarchical clustering reveals clusters with a high and low degree of immune infiltration, with a differential ICI response rate. Immune-associated gene sets were enriched in responders. Signatures associated with cancer-associated fibroblasts, macrophages, and TGF-β signaling may be higher in immune-infiltrated, but ICI-unresponsive tumors, suggesting a role for these resistance mechanisms in MucM. Our data show organ region–specific differences in immune infiltration and IFN-γ signature levels in MucM, with H&N MucM displaying the most favorable immune profile. Our study might offer a starting point for developing more personalized treatment strategies for this disease.

Authors

Joris L. Vos, Joleen J.H. Traets, Xiaohang Qiao, Iris M. Seignette, Dennis Peters, Michel W.J.M. Wouters, Erik Hooijberg, Annegien Broeks, Jacqueline E. van der Wal, M. Baris Karakullukcu, W. Martin C. Klop, Arash Navran, Marc van Beurden, Oscar R. Brouwer, Luc G.T. Morris, Mariette I.E. van Poelgeest, Ellen Kapiteijn, John B.A.G. Haanen, Christian U. Blank, Charlotte L. Zuur

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Figure 4

Microenvironmental correlates of response to ICI in mucosal melanoma.

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Microenvironmental correlates of response to ICI in mucosal melanoma.
(A...
(A) Heatmap of samples’ Danaher leukocyte RNA signatures, ordered by the mean across all signatures (the TIL-score). (B) Heatmap of genes associated with IFN-γ signaling (23), ordered by mean expression the IFN-γ signature. (C) Box plots of Z-scores of CD8+ T cell and IFN-γ signatures per ICI response category (responders, green; nonresponders, red). (D) Enrichment analysis of Hallmark gene sets (32) in responders and nonresponders, ordered by FDR. (E) Heatmap visualizing TIDE signatures (33) associated with CAFs, MDSCs, and TAMs in all patients from the more-infiltrated cluster defined in Figure 3D. Heatmap is organized by the mean across the 3 signatures. (F) Box plots of TIDE signature values in responders vs. nonresponders from the more-infiltrated cluster. (G) Box plots displaying the TGF-β signatures in responders vs. nonresponders from the more-infiltrated cluster. (H) Box plot visualizing the mIF-assessed stromal CD8+ T cell density in responding vs. nonresponding samples from the more-infiltrated cluster. Tracks in A, B, and E annotate sample’s primary site of origin and best objective response, with asterisks indicating tumprs that progressed in the context ofa mixed response. Boxes in C and F–H indicate the median and IQR; with whiskers extending up to 1.5 times the IQR. Exact P values in C and F–H were calculated using a Wilcoxon’s rank-sum test. Dot colors represent samples’ site of primary MucM origin. H&N, head and neck; SN, sinonasal; OC, oral cavity, FUT, female urogenital tract; MUT, male urogenital tract; AR, anorectal; GI, gastrointestinal; BOR, best objective response; NR, no response; R, response; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; MR, mixed response; TIDE, tumor immune dysfunction and exclusion; MDSC, myeloid-derived suppressor cell; CAF, cancer-associated fibroblast; TAM, tumor-associated macrophage; APM, antigen-presenting machinery.

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