As our understanding of the factors which affect efficacy of a targeted therapy increases, the reliance on histopathological analysis of a biomarker has also increased. This is often due to the necessity to weigh the critical factors of a target or biomarker protein in tissue and cellular context. Currently, histopathologic assessment of tumors which aims to project patient clinical outcome utilize drug target response factors, such as relative expression of the drug target of the drug target or a resistance mechanism in the target (tumor) cells or the tumor microenvironment (TME ). Multiple studies have also shown that TME factors such as inflammatory cell content can be prognostic and predictive. For example, adding the Immunoscore assessment to the TNM classification systems improves the accuracy of disease prognosis. This correlation has led to the concept of predictive “immunoprofiling”, which uses an individual's immune system profile to predict that patient's response to immunomodulating antibody therapy. For these reasons, it is critical to evaluate the drug target or biomarker in conjunction with TME features when defining a patient selection strategy.

Critical factors such as tissue and/or cellular compartmentalization and tumor heterogeneity direct the interpretation of these measures and their predictive value. To address the need for careful, contextual interpretation of histopathological evaluations, Flagship has built CellMap™ image analysis algorithms to directly measure heterogeneity and the TME components in a whole tissue section. These approaches allow biomarker interpretation in the complex context of spatial, architectural, and morphological information to aid histological definition and quantification. In this study, we utilized a cohort of specimens from 20 colorectal cancer (CRC) patients and immunologically stained them in order to visualize c-Met, as a characteristic and biologically relevant therapy target; and CD3+ and CD8+ to visualize the inflammatory cell environment. Using these immunohistochemical markers as a prototype for a simultaneous evaluation of a molecular target and the TME, we characterized the biomarker and inflammatory content in both the tumor and stroma using our CellMap™ image analysis algorithms. This provided detailed accounting of the molecular target profile (tumor vs stroma; membrane vs cytoplasm vs nucleus), and the “immunoprofile”, which allowed us to quantitatively describe and associate these features relative to each other in the context of heterogeneity. This data demonstrated discrete patterns of association between c-met and the TME, serving as a potentially critical measure which reflects a biological process relevant to disease outcome. These studies demonstrate novel tools which can assess both the prognostic and predictive value of key measurements which reflect complex tumor biology.

Citation Format: Joseph S. Krueger, Brian Laffin, Holger Lange, Anthony Milici, Mirza Peljto, Eric Neeley, Mahipal Suraneni, David Young. Evaluating the contribution of heterogeneity and the tumor microenvironment in companion diagnostic approaches. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4981. doi:10.1158/1538-7445.AM2014-4981