Weakly supervised deep learning predicts immunotherapy response in solid tumors based on PD-L1 expression

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Marta Ligero - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Garazi Serna - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Omar S M El Nahhas - , Else Kröner Fresenius Center for Digital Health (Author)
  • Irene Sansano - , Vall d'Hebron University Hospital (Author)
  • Siarhei Mauchanski - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Cristina Viaplana - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Julien Calderaro - , Hôpital Henri Mondor (Author)
  • Rodrigo A Toledo - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Rodrigo Dienstmann - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Rami S Vanguri - , Children's Hospital of Philadelphia (CHOP) (Author)
  • Jennifer L Sauter - , Memorial Sloan-Kettering Cancer Center (Author)
  • Francisco Sanchez-Vega - , Memorial Sloan-Kettering Cancer Center (Author)
  • Sohrab P Shah - , Memorial Sloan-Kettering Cancer Center (Author)
  • Santiago Ramón Y Cajal - , Vall d'Hebron University Hospital (Author)
  • Elena Garralda - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Paolo Nuciforo - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Raquel Perez-Lopez - , Vall d'Hebron Institute of Oncology (VHIO) (Author)
  • Jakob Nikolas Kather - , Else Kröner Fresenius Center for Digital Health, Department of Internal Medicine I, National Center for Tumor Diseases Dresden, University of Leeds (Author)

Abstract

Programmed death-ligand 1 (PD-L1) IHC is the most commonly used biomarker for immunotherapy response. However, quantification of PD-L1 status in pathology slides is challenging. Neither manual quantification nor a computer-based mimicking of manual readouts is perfectly reproducible, and the predictive performance of both approaches regarding immunotherapy response is limited. In this study, we developed a deep learning (DL) method to predict PD-L1 status directly from raw IHC image data, without explicit intermediary steps such as cell detection or pigment quantification. We trained the weakly supervised model on PD-L1-stained slides from the non-small cell lung cancer (NSCLC)-Memorial Sloan Kettering (MSK) cohort (N = 233) and validated it on the pan-cancer-Vall d'Hebron Institute of Oncology (VHIO) cohort (N = 108). We also investigated the performance of the model to predict response to immune checkpoint inhibitors (ICI) in terms of progression-free survival. In the pan-cancer-VHIO cohort, the performance was compared with tumor proportion score (TPS) and combined positive score (CPS). The DL model showed good performance in predicting PD-L1 expression (TPS ≥ 1%) in both NSCLC-MSK and pan-cancer-VHIO cohort (AUC 0.88 ± 0.06 and 0.80 ± 0.03, respectively). The predicted PD-L1 status showed an improved association with response to ICIs [HR: 1.5 (95% confidence interval: 1-2.3), P = 0.049] compared with TPS [HR: 1.4 (0.96-2.2), P = 0.082] and CPS [HR: 1.2 (0.79-1.9), P = 0.386]. Notably, our explainability analysis showed that the model does not just look at the amount of brown pigment in the IHC slides, but also considers morphologic factors such as lymphocyte conglomerates. Overall, end-to-end weakly supervised DL shows potential for improving patient stratification for cancer immunotherapy by analyzing PD-L1 IHC, holistically integrating morphology and PD-L1 staining intensity. SIGNIFICANCE: The weakly supervised DL model to predict PD-L1 status from raw IHC data, integrating tumor staining intensity and morphology, enables enhanced patient stratification in cancer immunotherapy compared with traditional pathologist assessment.

Details

Original languageEnglish
Pages (from-to)92-102
Number of pages11
Journal Cancer research communications / AACR
Volume4
Issue number1
Early online date21 Dec 2023
Publication statusPublished - Jan 2024
Peer-reviewedYes

External IDs

Scopus 85201277720

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • B7-H1 Antigen/analysis, Carcinoma, Non-Small-Cell Lung/therapy, Deep Learning, Humans, Immunotherapy/methods, Lung Neoplasms/therapy

Library keywords