Characterizing diversity in the tumor-immune microenvironment of distinct subclasses of gastroesophageal adenocarcinomas.

BACKGROUND: Gastroesophageal adenocarcinomas (GEA) are heterogeneous cancers where immune checkpoint inhibitors (ICI) have robust efficacy in heavily inflamed microsatellite instability (MSI) or Epstein-Barr Virus (EBV) positive subtypes. ICI responses are markedly lower in diffuse/genome-stable (GS) and chromosomal instable (CIN) GEAs. In contrast to EBV and MSI subtypes, the tumor microenvironment of CIN and GS GEAs have not been fully characterized to date, which limits our ability to improve immunotherapeutic strategies.

PATIENTS AND METHODS: Here we aimed to identify tumor-immune cell association across GEA subclasses using data from The Cancer Genome Atlas (TCGA) (N=453 GEAs) and archival GEA resection specimen (N=63). TCGA RNAseq data were used for computational inferences of immune cell subsets, which were correlated to tumor characteristic within and between subtypes. Archival tissues were used for more spatial immune characterization spanning immunohistochemistry and mRNA expression analyses.

RESULTS: Our results confirmed substantial heterogeneity in TME between distinct subtypes. While MSI-high and EBV+ GEAs harbored most intense T cell infiltrates, the GS group showed enrichment of CD4+T cells, macrophages and B cells and, in ∼50% of cases, evidence for tertiary lymphoid structures (TLSs). In contrast, CIN cancers possessed CD8+T cells predominantly at the invasive margin while tumor associated macrophages (TAMs) showed tumor infiltrating capacity. Relatively T cell-rich 'hot' CIN GEAs were often from Western patients, while immunological 'cold' CIN GEAs showed enrichment of MYC and cell cycle pathways, including amplification of CCNE1.

CONCLUSION: These results reveal the diversity of immune phenotypes of GEA. Half of GS GCs have TLSs and are therefore promising candidates for immunotherapy. The majority of CIN GEAs, however, exhibit T cell exclusion and infiltrating macrophages. Associations of immune-poor CIN GEAs with MYC activity and CCNE1 amplification may enable new studies to determine precise mechanisms of immune evasion, ultimately inspiring new therapeutic modalities.