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  • 1
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 4, No. S2 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2016
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  • 2
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 7, No. 1 ( 2019-12)
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 3
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 78, No. 16_Supplement ( 2018-08-15), p. A069-A069
    Abstract: Introduction: The composition of different immune cell populations in the tumor microenvironment plays an important role for tumor progression in various cancer types. In particular, tumor-associated macrophages (TAMs) and tumor-infiltrating T cells (TILs) are relevant players. On the other hand, structural changes such as neoangiogenesis triggered by cancerous tumors to increase their nutrient supplies have also been associated with tumor progression. In this work we systematically quantified these factors in prostate cancer (PCa) and correlated them with clinical outcome data using a Tissue Phenomics approach. By investigating the prognostic relevance of TAMs (CD68/CD163), TILs (CD3/CD8), and microvessels (CD34) in the tumor, tumor microenvironment (TME), and stroma we identified strong prognostic markers for PCa recurrence prediction in patients after radical prostatectomy. Methods: In this study, we analyzed a cohort of 90 PCa patients, of whom 40 suffered from tumor progression measured by prostate cancer antigen (PSA) recurrence after prostatectomy. The cohort comprised low- and intermediate-risk PCa patients (Gleason-Score≤7b) since providing a reliable prognosis is particularly difficult for such grades. Tissue sections were immunohistochemically stained using the duplex stains CD68/CD163 for TAMs, CD3/CD8 for TILs, and CK18/p63 to identify and characterize glands as cancerous vs. noncancerous based on their expression level of p63 (in cancerous glands p63 is not expressed). To quantify tumor neoangiogenesis microvessels were stained by CD34. All sections were geometrically aligned per case (virtual multiplexing) to enable coanalysis of stains, and quantified within relevant regions-of-interest (tumor, TME, stroma) using fully automated computational methods (1, 2). In particular, we determined region-specific densities and average distances of TAMs, TILs, and microvessels, as well as ratios of all measures. We systematically analyzed the prognostic power of each measure by optimizing a cutoff with respect to the disease-free survival statistic (log-rank test) using cross-validation to avoid for overfitting. Results: The top-ranking prognostic markers regarding robustness and prediction performance were related to microvessel density combined with immune cell densities. In particular, we found that within the TME, a coverage of CD8(+) cytotoxic T cells larger than 10% of the coverage of CD34(+) microvessels is correlated with a good prognosis and long-term disease-free survival (cross-validated p & lt;3.1•10-7, accuracy=83%). This corresponds to high densities of CD8(+) cells and/or low microvessel densities, which both have been shown to be associated with good prognosis in prostate cancer. In addition, we found that a larger average distance of CD68(+) M1 macrophages to CD34(+) microvessels above 75.7µm in the tumor region is associated with good prognosis (cross-validated p & lt;2.9•10-8, accuracy=82%). Again, low tumor microvessel density seems to be beneficial as well as high densities of CD68(+) macrophages. The CD68(+) M1-polarized phenotype is associated with tumor-suppressing properties, indicating that a higher density of this population compared to the tumor-promoting M2-polarized phenotype fosters disease-free survival. Conclusion: Our results indicate a considerable prognostic potential of markers combining microvessel density with measures of TAMs and TILs to predict PSA recurrence in PCa. This application shows that systematic analysis as performed by Tissue Phenomics enables discovery of non-obvious combined prognostic markers characterizing the tumor landscape with high potential to improve patient treatment. In future work we aim to validate our findings on additional data from other clinical sites. References: 1. Yigitsoy M, et al. Hierarchical patch-based co-registration of differently stained histopathology slides. Proc SPIE 2017. doi:10.1117/12.2254266. 2. Brieu N, et al. Slide specific models for segmentation of differently stained digital histopathology whole slide images. Proc SPIE 2016. doi:10.1117/12.2208620. Citation Format: Nathalie Harder, Maria Athelogou, Harald Hessel, Alexander Buchner, Christian Stief, Thomas Kirchner, Günter Schmidt, Ralf Huss, Tze Heng Tan. Combination of immune status and tumor microvascularization provides strong prognostic markers for prostate cancer recurrence prediction [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr A069.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2018
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  • 4
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 468-468
    Abstract: Many targeted cancer therapies rely on biomarkers, which are assessed by standard pathologist scoring of immunohistochemically stained tissue. However, this process is subjective, semi-quantitative and does not assess expression heterogeneity. A quantitative method to measure IHC markers might therefore significantly improve patient selection particularly of proteins expressed at low levels. To address these challenges, we have developed the Quantitative Continuous Scoring (QCS) that deploys the power of fully supervised Deep Learning (DL) algorithms to provide objective and continuous data of biomarkers in digitized IHC whole slide images (WSI). The two DL-based algorithms, developed using pathologist input as the ground truth, identify areas of invasive tumor and segment each individual tumor cell across the WSI into pixels that represent cell nuclei, cytoplasm and/or membrane. This allows to compute biomarker expression as mean Optical Density (OD) in each of these subcellular compartments based on the Hue-Saturation-Density (HSD) model. Of note, this also allows computation of the spatial distribution of tumor cells across the WSI. The measured OD for each cell is aggregated as a histogram to quantitative continuous readouts for each patient sample. The method’s ability to accurately detect low expression range facilitates selection of antibody clones for IHC assays, has been successfully used to delineate mode of action and PK/PD mechanisms, has provided surrogate markers of spatial expression heterogeneity to predict potential bystander activity and has facilitated marker co-expression analysis to inform rational combination therapies. In retrospective clinical trials analysis, QCS showed superior performance in identifying a patient population gaining maximum treatment benefit. QCS-based quantification of PD-L1 membrane expression was able to stratify anti-PD-L1 treated late-stage non-small cell lung cancer (NSCLC) patients [NCT01693562] with a higher prevalence and more significant log rank p-value (64%, p=0.0001) for OS compared to pathologist TPS (59%, p=0.01). In summary, we describe a computational pathology-based approach for precise biomarker quantification and superior patient selection with broad applicability and the potential to transform pathology, thus addressing one of the key challenges of precision oncology. Citation Format: Hadassah Sade, Ansh Kapil, Philipp Wortmann, Andreas Spitzmueller, Nicolas Triltsch, Lina Meinecke, Susanne Haneder, Anatoliy Shumilov, Jan Lesniak, Valeria Bertani, Tze-Heng Tan, Ana Hidalgo-Sastre, Simon Christ, Andrea Storti, Regina Alleze, Dasa Medrikova, Jessica Chan, Simon Lanzmich, Markus Schick, Guenter Schmidt, J. Carl Barrett. Quantitative assessment of IHC using computational pathology allows superior patient selection for biomarker-informed patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 468.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 5
    In: Nature Methods, Springer Science and Business Media LLC, Vol. 8, No. 3 ( 2011-3), p. 246-249
    Type of Medium: Online Resource
    ISSN: 1548-7091 , 1548-7105
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
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  • 6
    In: The Journal of Pathology: Clinical Research, Wiley, Vol. 6, No. 2 ( 2020-04), p. 124-137
    Abstract: Anti‐PD‐1/PD‐L1 immunotherapy could offer an alternative to traditional chemo‐ and/or radiotherapy to treat pediatric cancer patients. To unveil the potential benefit of this new therapeutic approach, the prevalence of PD‐L1 and other relevant immune markers using quantitative digital image analysis (DIA) could help to clarify this point. A bridging study was first conducted using commercially available normal formalin‐fixed paraffin‐embedded (FFPE) tonsils to compare immunostaining patterns and intensities from PD‐L1, tumor infiltrating lymphocyte (TIL) markers CD3, CD8, FoxP3, CD45RO, and macrophage marker CD68 in adult ( n = 5) and pediatric ( n = 10) samples. Then, commercially available pediatric FFPE tumor samples from five prevalent pediatric solid tumor indications: ganglioneuroblastoma ( n = 7); neuroblastoma ( n = 23); nephroblastoma ( n = 30); osteosarcoma ( n = 24); and rhabdomyosarcoma ( n = 25) were immunostained and their images ( n = 654) digitally analyzed using predefined algorithms. The qualitative analysis of staining patterns and intensities in all 15 tonsils for all 6 biomarkers was similar regardless of age category. Quantitative DIA showed that PD‐L1 values varied across cancer‐types, nephroblastoma having the lowest counts. PD‐L1 counts in ganglioneuroblastoma, our pediatric indication with the highest average value, was approximately 12‐times lower than in a similar nonsmall cell lung cancer study, an indication approved for anti‐PD‐1/PD‐L1 immunotherapies. Variable values were measured for the TIL markers CD3, CD8, and CD45RO. FoxP3 was scant across all indications. The macrophage marker CD68 showed highest values in ganglioneuroblastoma, with lowest levels in nephroblastoma. In conclusion, the low PD‐L1 levels uncorrelated with TIL values from the present biomarker morphological study suggest that a PD‐L1 immunohistochemistry patient selection strategy used for anti‐PD‐1/PD‐L1 monotherapy in adult tumors may not succeed in these pediatric indications.
    Type of Medium: Online Resource
    ISSN: 2056-4538 , 2056-4538
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 452-452
    Abstract: Antibody-Drug-Conjugates (ADCs) are biopharmaceutical drugs designed for targeted tumor therapy, meant to improve therapeutic index by restricting drug delivery to tumor cells that express the target antigen. ADCs bind to the target molecule on the cell membrane, which triggers internalization, linker cleavage, and ultimately drug release inside the target cell. Prospective patient selection can be done by quantifying the level of target expression in the tumor using immuno-histochemistry (IHC). However, this process typically involves pathologists and is time consuming, expensive, and prone to human bias. We have developed a supervised deep learning algorithm that segments IHC images of invasive tumor epithelium into individual epithelial cells and their membrane, cytoplasm and nucleus with high accuracy. On unseen test data its performance for epithelial cell detection and segmentation is comparable to the inter-pathologist consensus. With our algorithm, we can describe the target molecule distribution of individual cells in a fully quantitative fashion after using standard IHC methods: we call our approach Quantitative Continuous Score (QCS). We applied QCS to interrogate the mechanism of action of AZD8205, a B7-H4 directed ADC incorporating a novel topoisomerase I linker-warhead. Pharmacodynamic effects were evaluated in vivo, using a human tumor xenograft mouse model and the cell line HT29-huB7-H4 Clone 26, engineered to express human B7-H4. After tumors grew in volume to approximately 250 to 300 mm3, animals were randomized and each mouse received an IV injection of either AZD8205 (1.25, 3.5, or 7 mg/kg) or control articles. Tumors were collected at designated timepoints, fixed in 10% neutral buffered formalin and subsequently embedded into paraffin blocks. IHC and QCS were then used to examine human IgG, γH2AX foci, cleaved caspase-3, and epithelial cell density in tumor samples over time. Using our novel approach we could quantitatively measure the level of AZD8205 bound to tumor cells, with the highest level of ADC on the cell membrane detected at 24-48 hrs. Increased dose levels accelerated the binding kinetics of the drug and led to to a 4- and 3-fold excess of γH2AX and CC-3 respectively, as well as more cells being killed, with up to 2/3 of all epithelial cells dead at the highest dose studied. In summary, we here set the basis for future mechanistic investigation of model systems using computational pathology to improve our understanding of ADC effects. Computational pathology has the potential to determine molecule abundance quantitatively, increase throughput and avoid human bias. Our data implies QCS has the potential to identify patients who may respond to AZD8205, which we will interrogate further and integrate into future clinical studies. Citation Format: Philipp Wortmann, Tze Heng Tan, Susanne Haneder, Andrea Ennio Storti, Ansh Kapil, Jon Chesebrough, Daniel Sutton, Michal Sulikowski, Arthur Lewis, Sofia Koch, Steve Sweet, Zifeng Song, David Chain, Yeoun Jin Kim, Nadia Luheshi, Krista Kinneer, Zachary A. Cooper, Marlon Rebelatto, Günter Schmidt, Hadassah Sade, J. Carl Barrett. Development and implementation of image analysis-based Quantitative Continuous Score (QCS) for B7-H4 IHC to understand AZD8205 pharmacodynamics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 452.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 8
    In: Cancer Discovery, American Association for Cancer Research (AACR), ( 2023-09-14)
    Abstract: Neoadjuvant chemo-immunotherapy improves pathological complete response rate and event-free survival in patients with resectable non-small-cell lung cancer (NSCLC), versus chemotherapy alone. NeoCOAST was the first randomized, multi-drug, platform trial to examine novel neoadjuvant immuno-oncology combinations for patients with resectable NSCLC, using major pathological response (MPR) as the primary endpoint. Eighty-three patients received a single cycle of treatment: 26 received durvalumab (anti-PD-L1) monotherapy, 21 received durvalumab plus oleclumab (anti-CD73), 20 received durvalumab plus monalizumab (anti-NKG2A), and 16 received durvalumab plus danvatirsen (anti-STAT3 antisense oligonucleotide). MPR rates were higher for patients in the combination arms, versus durvalumab alone. Safety profiles for the combinations were similar to that of durvalumab alone. Multiplatform immune profiling suggested improved MPR rates in the durvalumab plus oleclumab and durvalumab plus monalizumab arms were associated with enhanced effector immune infiltration of tumors, interferon responses and markers of tertiary lymphoid structure formation, and systemic functional immune-cell activation.
    Type of Medium: Online Resource
    ISSN: 2159-8274 , 2159-8290
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 9
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2019
    In:  Cancer Research Vol. 79, No. 13_Supplement ( 2019-07-01), p. 2795-2795
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 79, No. 13_Supplement ( 2019-07-01), p. 2795-2795
    Abstract: The overall density of CD8+ tumor-infiltrating lymphocytes (TILs) is important for characterizing the level of immune activity in the tumor microenvironment (TME). Beyond the densities of CD8+ TILs, both their location and distributional patterns may also have relevance to immune activity. We evaluated 645 resected tumors encompassing seven cancer types, and correlate location and spatial patterns of CD8+ TILs to immune pathway activity. We integrated image analysis results from digitized immunohistochemistry (IHC) slides with gene expression data from a targeted Ion Torrent Panel. Overall density of CD8+ TILs and the exact position of individual CD8+ lymphocytes were determined from IHC slides. A dissemination score was defined as ratio of global density and average local density of CD8+ TILs. This score is the inverse of the Ripley’s K statistic and becomes high for disseminated spatial patterns. We used this quotient as a continuous metric to identify tumors with a disseminated TIL pattern and to distinguish them from tumors with focal distribution of CD8+ TILs. Within a subset of tumors, the continuous dissemination metric was correlated with biological pathways using targeted mRNA sequencing and gene set enrichment analysis. In addition, association of the dissemination score with overall survival was tested on a subset of cases. CD8+ TIL distributional patterns differed significantly between tumor types. Breast and pancreatic cancers more frequently showed a focal distribution of CD8+ TILs, while lung tumors comparatively exhibited a disseminated pattern. Transcriptional profiling data revealed differences between both image analysis phenotypes. On average, cases with more disseminated patterns of CD8+ T cells were associated with mRNA expression of genes that fall in pathways related to motility, migration and activation status of tumor infiltrating T cells. We also found a trend to better overall survival in patients whose tumors had a disseminated TIL score compared to those with a focal pattern. This trend was significant in non-small cell adenocarcinoma of the lung (log rank p = 0.018). We demonstrate the value of spatial image analysis to automatically score CD8+ TIL dissemination as a marker of immune activity in the TME. Jointly analyzing transcriptional profiles appears to identify a biologically meaningful activation phenotype in tumors with high dissemination scores. Our data further suggests that this phenotype is associated with improved overall survival in some cancer patients. Citation Format: Stefan Bentink, Andreas Spitzmueller, Tze Heng Tan, Hadassah Sade, Song Wu, Brandon W. Higgs, Keith E. Steele. Dissemination score of CD8+ TILs by automated image analysis is a potential marker of immune activity in human cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2795.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2019
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  • 10
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 6, No. 1 ( 2018-12)
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2018
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