ESMO Congress 2023

At the last ESMO Congress 2023 in Madrid, the GONO Foundation research group presented results from the latest translational analysis of the AtezoTRIBE trial, which has recently demonstrated that adding atezolizumab to first-line FOLFOXIRI/bevacizumab prolongs progression-free survival in metastatic colorectal cancer (mCRC) patients. Thanks to an international collaboration with Lunit inc, based in Korea, an artificial intelligence-powered whole-slide images (WSI) analyzer – LunitIO – was applied in order to analyze tumour infiltrating lymphocytes (TILs) in hematoxylin & eosin-stained WSI of tumour specimens collected at baseline from patients enrolled in the AtezoTRIBE study cohort. Lunit Scope IO identifies three immune-phenotypes, defined as: inflamed, characterized by TILs in tumor epithelium and stroma; excluded, with TILs-enriched stroma; desert, lacking in TILs. Contextually, inflamed score was calculated as the proportion of grids classified as inflamed within a whole slide image. Of 154 cases analyzed, 56% were immune-desert and 44% were immune-excluded, while no immune-inflamed cases were detected. Both immune phenotypes and inflamed score were correlated with well-known immune-related biomarkers (e.g. Immunoscore IC, Immunoscore, TMB, MMR status and TILs’ density by optical microscope), although no prognostic nor predictive roles were observed. Nevertheless, both parameters provide additional characterization of the tumor microenvironment in mCRC. Further development of Lunit Scope IO tools is currently ongoing with the aim to identify novel biomarkers of tumour immunogenicity, potentially predictive of benefit from the addition of atezolizumab to first-line FOLFOXIRI plus bevacizumab.