A pre‐existing coordinated inflammatory microenvironment is associated with complete response of vulvar high‐grade squamous intraepithelial lesions to different forms of immunotherapy
International Journal of Cancer, vol. 147, pp. 2914–2923
Abstract
Abstract Immunotherapy of vulvar high‐grade squamous intraepithelial lesion (vHSIL) is investigated as an alternative for surgery, because of high comorbidity and risk of recurrence. Limited evidence exists on the role and composition of the immune microenvironment in current immunotherapeutic approaches for vHSIL. The vHSIL of 29 patients biopsied before treatment with imiquimod were analyzed by two multiplex seven‐color immunofluorescence panels to investigate the pre‐existing T‐cell and myeloid cell composition in relation to treatment response. The samples were scanned with the Vectra multispectral imaging system. Cells were automatically phenotyped and counted with inForm advanced image analysis software. Cell counts and composition were compared to that of vHSIL patients before therapeutic vaccination (n = 29) and to healthy vulva (n = 27). Our data show that the immune microenvironment of complete responders (CR) to imiquimod resembled the coordinated infiltration with type 1 CD4+ and CD8+ T cells and CD14+ inflammatory myeloid cells also found in healthy vulva. However, more CD8+ T cells and FoxP3+ regulatory T cells were present in CR. The lesions of partial responders (PR) lacked such a coordinated response and displayed an impaired influx of CD14+ inflammatory myeloid cells. Importantly, complete responses after imiquimod or therapeutic vaccination showed the same dependency on a pre‐existing coordinated type 1 T‐cell and CD14+ myeloid cell infiltration. In conclusion, a good clinical outcome after two different forms of immunotherapy for vHSIL is associated with the presence of a primary inflammatory process resulting in the coordinated influx of several types of immune cells which is then amplified.
Authors 7
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Ziena Abdulrahman Aachen Department of Gynaecology Leiden University Medical Center Leiden The Netherlands Department of Medical Oncology Department of Pathology Leiden University Medical Center Leiden The Netherlands Department of Gynaecology, Leiden University Medical Center Oncode Institute Department of Pathology, Leiden University Medical Center
Leiden University Medical Center · Oncode Institute
Affiliation as printed
Department of Gynaecology Leiden University Medical Center Leiden The Netherlands
Department of Medical Oncology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
Department of Pathology Leiden University Medical Center Leiden The Netherlands
Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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Noel F.C.C. de Miranda Aachen Department of Pathology Leiden University Medical Center Leiden The Netherlands Department of Pathology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Pathology Leiden University Medical Center Leiden The Netherlands
Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Gynaecology Haga Hospital Den Haag The Netherlands
Department of Gynaecology, Haga Hospital, Den Haag, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Gynaecology Maastricht University Medical Center Maastricht The Netherlands
Department of Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
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Affiliation as printed
Department of Gynaecology Catharina Hospital Eindhoven The Netherlands
Department of Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
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Leiden University Medical Center · Oncode Institute
Affiliation as printed
Department of Medical Oncology, Oncode Institute Leiden University Medical Center Leiden The Netherlands
Department of Medical Oncology, Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
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Mariëtte I.E. van Poelgeest Aachen Department of Gynaecology Leiden University Medical Center Leiden The Netherlands Department of Gynaecology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Gynaecology Leiden University Medical Center Leiden The Netherlands
Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
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Cited by patents worldwide 1 (Lens.org)
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BIOMARKER FOR PREDICTING THE RESPONSE TO TLR 7-AGONIST IMMUNOTHERAPY OF SQUAMOUS INTRAEPITHELIAL LESIONS AND THERAPEUTIC USE THEREOFWO2023222710A1 2023-11-23 Pending Aachen patent