Evolution of delayed resistance to immunotherapy in a melanoma responder

D Liu, JR Lin, EJ Robitschek, GG Kasumova… - Nature medicine, 2021 - nature.com
D Liu, JR Lin, EJ Robitschek, GG Kasumova, A Heyde, A Shi, A Kraya, G Zhang, T Moll
Nature medicine, 2021nature.com
Despite initial responses,–, most melanoma patients develop resistance to immune
checkpoint blockade (ICB). To understand the evolution of resistance, we studied 37 tumor
samples over 9 years from a patient with metastatic melanoma with complete clinical
response to ICB followed by delayed recurrence and death. Phylogenetic analysis revealed
co-evolution of seven lineages with multiple convergent, but independent resistance-
associated alterations. All recurrent tumors emerged from a lineage characterized by loss of …
Abstract
Despite initial responses, –, most melanoma patients develop resistance to immune checkpoint blockade (ICB). To understand the evolution of resistance, we studied 37 tumor samples over 9 years from a patient with metastatic melanoma with complete clinical response to ICB followed by delayed recurrence and death. Phylogenetic analysis revealed co-evolution of seven lineages with multiple convergent, but independent resistance-associated alterations. All recurrent tumors emerged from a lineage characterized by loss of chromosome 15q, with post-treatment clones acquiring additional genomic driver events. Deconvolution of bulk RNA sequencing and highly multiplexed immunofluorescence (t-CyCIF) revealed differences in immune composition among different lineages. Imaging revealed a vasculogenic mimicry phenotype in NGFRhi tumor cells with high PD-L1 expression in close proximity to immune cells. Rapid autopsy demonstrated two distinct NGFR spatial patterns with high polarity and proximity to immune cells in subcutaneous tumors versus a diffuse spatial pattern in lung tumors, suggesting different roles of this neural-crest-like program in different tumor microenvironments. Broadly, this study establishes a high-resolution map of the evolutionary dynamics of resistance to ICB, characterizes a de-differentiated neural-crest tumor population in melanoma immunotherapy resistance and describes site-specific differences in tumor–immune interactions via longitudinal analysis of a patient with melanoma with an unusual clinical course.
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