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Mandula JK, Sierra-Mondragon RA, Jimenez RV, Chang D, Mohamed E, Chang S, Vazquez-Martinez JA, Cao Y, Anadon CM, Lee SB, Das S, Rocha-Munguba L, Pham VM, Li R, Tarhini AA, Furqan M, Dalton W, Churchman M, Moran-Segura CM, Nguyen J, Perez B, Kojetin DJ, Obermayer A, Yu X, Chen A, Shaw TI, Conejo-Garcia JR, Rodriguez PC. Jagged2 targeting in lung cancer activates anti-tumor immunity via Notch-induced functional reprogramming of tumor-associated macrophages. Immunity 2024:S1074-7613(24)00141-9. [PMID: 38636522 DOI: 10.1016/j.immuni.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Signaling through Notch receptors intrinsically regulates tumor cell development and growth. Here, we studied the role of the Notch ligand Jagged2 on immune evasion in non-small cell lung cancer (NSCLC). Higher expression of JAG2 in NSCLC negatively correlated with survival. In NSCLC pre-clinical models, deletion of Jag2, but not Jag1, in cancer cells attenuated tumor growth and activated protective anti-tumor T cell responses. Jag2-/- lung tumors exhibited higher frequencies of macrophages that expressed immunostimulatory mediators and triggered T cell-dependent anti-tumor immunity. Mechanistically, Jag2 ablation promoted Nr4a-mediated induction of Notch ligands DLL1/4 on cancer cells. DLL1/4-initiated Notch1/2 signaling in macrophages induced the expression of transcription factor IRF4 and macrophage immunostimulatory functionality. IRF4 expression was required for the anti-tumor effects of Jag2 deletion in lung tumors. Antibody targeting of Jagged2 inhibited tumor growth and activated IRF4-driven macrophage-mediated anti-tumor immunity. Thus, Jagged2 orchestrates immunosuppressive systems in NSCLC that can be overcome to incite macrophage-mediated anti-tumor immunity.
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Affiliation(s)
- Jay K Mandula
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Rachel V Jimenez
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Darwin Chang
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Eslam Mohamed
- California Northstate University, Elk Grove, CA 95757, USA
| | - Shiun Chang
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Yu Cao
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Carmen M Anadon
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC 27708, USA
| | - Sae Bom Lee
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Satyajit Das
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Léo Rocha-Munguba
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Vincent M Pham
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ahmad A Tarhini
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Muhammad Furqan
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA 52242, USA
| | | | | | - Carlos M Moran-Segura
- Advanced Analytical and Digital Laboratory, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jonathan Nguyen
- Advanced Analytical and Digital Laboratory, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Bradford Perez
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Douglas J Kojetin
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Alyssa Obermayer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Xiaoqing Yu
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ann Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Timothy I Shaw
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jose R Conejo-Garcia
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC 27708, USA
| | - Paulo C Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
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Mandula JK, Chang S, Mohamed E, Jimenez R, Sierra-Mondragon RA, Chang DC, Obermayer AN, Moran-Segura CM, Das S, Vazquez-Martinez JA, Prieto K, Chen A, Smalley KSM, Czerniecki B, Forsyth P, Koya RC, Ruffell B, Cubillos-Ruiz JR, Munn DH, Shaw TI, Conejo-Garcia JR, Rodriguez PC. Ablation of the endoplasmic reticulum stress kinase PERK induces paraptosis and type I interferon to promote anti-tumor T cell responses. Cancer Cell 2022; 40:1145-1160.e9. [PMID: 36150390 PMCID: PMC9561067 DOI: 10.1016/j.ccell.2022.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
Activation of unfolded protein responses (UPRs) in cancer cells undergoing endoplasmic reticulum (ER) stress promotes survival. However, how UPR in tumor cells impacts anti-tumor immune responses remains poorly described. Here, we investigate the role of the UPR mediator pancreatic ER kinase (PKR)-like ER kinase (PERK) in cancer cells in the modulation of anti-tumor immunity. Deletion of PERK in cancer cells or pharmacological inhibition of PERK in melanoma-bearing mice incites robust activation of anti-tumor T cell immunity and attenuates tumor growth. PERK elimination in ER-stressed malignant cells triggers SEC61β-induced paraptosis, thereby promoting immunogenic cell death (ICD) and systemic anti-tumor responses. ICD induction in PERK-ablated tumors stimulates type I interferon production in dendritic cells (DCs), which primes CCR2-dependent tumor trafficking of common-monocytic precursors and their intra-tumor commitment into monocytic-lineage inflammatory Ly6C+CD103+ DCs. These findings identify how tumor cell-derived PERK promotes immune evasion and highlight the potential of PERK-targeting therapies in cancer immunotherapy.
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Affiliation(s)
- Jessica K Mandula
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Shiun Chang
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Eslam Mohamed
- California Northstate University, Elk Grove, CA 95757, USA
| | - Rachel Jimenez
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Darwin C Chang
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Alyssa N Obermayer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Satyajit Das
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Karol Prieto
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ann Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Brian Czerniecki
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Peter Forsyth
- Department of NeuroOncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Richard C Koya
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Brian Ruffell
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Juan R Cubillos-Ruiz
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA
| | - David H Munn
- Department of Pediatrics, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Timothy I Shaw
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Paulo C Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
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Kim S, Wuthrick E, Blakaj D, Eroglu Z, Verschraegen C, Thapa R, Mills M, Dibs K, Liveringhouse C, Russell J, Caudell JJ, Tarhini A, Markowitz J, Kendra K, Wu R, Chen DT, Berglund A, Michael L, Aoki M, Wang MH, Hamaidi I, Cheng P, de la Iglesia J, Slebos RJ, Chung CH, Knepper TC, Moran-Segura CM, Nguyen JV, Perez BA, Rose T, Harrison L, Messina JL, Sondak VK, Tsai KY, Khushalani NI, Brohl AS. Combined nivolumab and ipilimumab with or without stereotactic body radiation therapy for advanced Merkel cell carcinoma: a randomised, open label, phase 2 trial. Lancet 2022; 400:1008-1019. [PMID: 36108657 PMCID: PMC9533323 DOI: 10.1016/s0140-6736(22)01659-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Merkel cell carcinoma is among the most aggressive and lethal of primary skin cancers, with a high rate of distant metastasis. Anti-programmed death receptor 1 (anti-PD-1) and programmed death ligand 1 (PD-L1) monotherapy is currently standard of care for unresectable, recurrent, or metastatic Merkel cell carcinoma. We assessed treatment with combined nivolumab plus ipilimumab, with or without stereotactic body radiotherapy (SBRT) in patients with advanced Merkel cell carcinoma as a first-line therapy or following previous treatment with anti-PD-1 and PD-L1 monotherapy. METHODS In this randomised, open label, phase 2 trial, we randomly assigned adults from two cancer sites in the USA (one in Florida and one in Ohio) to group A (combined nivolumab and ipilimumab) or group B (combined nivolumab and ipilimumab plus SBRT) in a 1:1 ratio. Eligible patients were aged at least 18 years with histologically proven advanced stage (unresectable, recurrent, or stage IV) Merkel cell carcinoma, a minimum of two tumour lesions measureable by CT, MRI or clinical exam, and tumour tissue available for exploratory biomarker analysis. Patients were stratified by previous immune-checkpoint inhibitor (ICI) status to receive nivolumab 240 mg intravenously every 2 weeks plus ipilimumab 1 mg/kg intravenously every 6 weeks (group A) or the same schedule of combined nivolumab and ipilimumab with the addition of SBRT to at least one tumour site (24 Gy in three fractions at week 2; group B). Patients had to have at least two measurable sites of disease so one non-irradiated site could be followed for response. The primary endpoint was objective response rate (ORR) in all randomly assigned patients who received at least one dose of combined nivolumab and ipilimumab. ORR was defined as the proportion of patients with a complete response or partial response per immune-related Response Evaluation Criteria in Solid Tumours. Response was assessed every 12 weeks. Safety was assessed in all patients. This trial is registered with ClinicalTrials.gov, NCT03071406. FINDINGS 50 patients (25 in both group A and group B) were enrolled between March 14, 2017, and Dec 21, 2021, including 24 ICI-naive patients (13 [52%] of 25 group A patients and 11 [44%] of 25 group B patients]) and 26 patients with previous ICI (12 [48%] of 25 group A patients and 14 [56%] of 25 group B patients]). One patient in group B did not receive SBRT due to concerns about excess toxicity. Median follow-up was 14·6 months (IQR 9·1-26·5). Two patients in group B were excluded from the analysis of the primary endpoint because the target lesions were irradiated and so the patients were deemed non-evaluable. Of the ICI-naive patients, 22 (100%) of 22 (95% CI 82-100) had an objective response, including nine (41% [95% CI 21-63]) with complete response. Of the patients who had previously had ICI exposure, eight (31%) of 26 patients (95% CI 15-52) had an objective response and four (15% [5-36]) had a complete response. No significant differences in ORR were observed between groups A (18 [72%] of 25 patients) and B (12 [52%] of 23 patients; p=0·26). Grade 3 or 4 treatment-related adverse events were observed in 10 (40%) of 25 patients in group A and 8 (32%) of 25 patients in group B. INTERPRETATION First-line combined nivolumab and ipilimumab in patients with advanced Merkel cell carcinoma showed a high ORR with durable responses and an expected safety profile. Combined nivolumab and ipilimumab also showed clinical benefit in patients with previous anti-PD-1 and PD-L1 treatment. Addition of SBRT did not improve efficacy of combined nivolumab and ipilimumab. The combination of nivolumab and ipilimumab represents a new first-line and salvage therapeutic option for advanced Merkel cell carcinoma. FUNDING Bristol Myers Squibb Rare Population Malignancy Program.
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Affiliation(s)
- Sungjune Kim
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
| | - Evan Wuthrick
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Claire Verschraegen
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Ram Thapa
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Matthew Mills
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Khaled Dibs
- Department of Radiation Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Casey Liveringhouse
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jeffery Russell
- Department of Head and Neck and Cutaneous Oncology, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ahmad Tarhini
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Joseph Markowitz
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kari Kendra
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Richard Wu
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lauren Michael
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Mia Aoki
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Min-Hsuan Wang
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Imene Hamaidi
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Pingyan Cheng
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Janis de la Iglesia
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robbert J Slebos
- Department of Head and Neck Endocrine Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Christine H Chung
- Department of Head and Neck Endocrine Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Todd C Knepper
- Department of Precision Medicine, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Carlos M Moran-Segura
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jonathan V Nguyen
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bradford A Perez
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Trevor Rose
- Department of Radiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Louis Harrison
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jane L Messina
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kenneth Y Tsai
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andrew S Brohl
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Kimmel GJ, Chakiryan NH, Kim Y, Hajiran AJ, Aydin AM, Nguyen JV, Moran-Segura CM, Dhillon J, Altrock P, Manley BJ. Abstract PO-034: Non-random spatial clustering of tumor associated macrophages is associated with poor survival in metastatic RCC patients receiving immunotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.tumhet2020-po-034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION Tumor associated macrophages (TAM) stimulate tumor proliferation and facilitate immune escape via production of immunosuppressive cytokines. We hypothesize that non-random spatial clustering of TAMs within the tumor is associated with poor survival in RCC patients. METHODS Primary and metastatic tumor specimens were obtained from 39 patients with metastatic RCC who received immunotherapy (IT). 29 patients (74.3%) also received targeted therapy (TT) at some point during their disease course. Sections from the tumor compartment underwent immunohistochemical (IHC) staining for pan-macrophage marker CD68, and M2 markers CD163 and CD206. Digital pathologic analysis was used to convert the digital images to spatial point pattern plots (PPP). A probability density function (PDF) for the distance between cells was calculated under the assumption that cells can be located anywhere in the slide with equal probability. The PDF was then compared to empirical histograms of cells derived from the PPP. Deviations from the PDF, the expected random distribution, reveal evidence of cell clustering or dispersion. We assessed deviations with the Kolmogorov-Smirnov (KS) test. Patients were stratified by the median value into high and low KS groups, and survival outcomes were compared between the two groups using a Cox regression. A high KS statistic indicates a good fit between the two curves (in this case, randomness), and a low KS statistic indicates a poor fit (in this case, dispersion or clustering). RESULTS Among primary tumor specimens, spatial clustering of CD68+ cells was associated with worse overall survival (OS) (HR -1.7, p=0.015), worse OS from IT initiation (HR -1.5, p=0.025), and no difference in OS from TT initiation (HR -0.4, p=0.48). Among metastatic tumor specimens, spatial clustering of CD68+ cells was not associated with any of the three survival outcomes (OS: HR 0.9, p=0.11; OS from IT: HR 0.7, p=0.20; OS from TT: HR 0.0, p=0.97). Spatial clustering of CD163+ cells was not associated with any of the three survival outcomes for either primary and metastatic sites. Spatial clustering of CD206+ cells was not associated with any of the three survival outcomes for either primary and metastatic sites. CONCLUSION Non-random spatial clustering of CD68+ TAMs in the primary tumor specimen was associated with worse survival, driven primarily by worse survival from initiation of immunotherapy. These findings corroborate prior reports of TAMs eliciting an immunosuppressive effect on the tumor-immune microenvironment, introduce novel methodology for quantifying spatial heterogeneity, and demonstrate the novel finding of a clinically significant effect of TAM spatial clustering on overall survival.
Citation Format: Gregory J. Kimmel, Nicholas H. Chakiryan, Youngchul Kim, Ali J. Hajiran, Ahmet M. Aydin, Jonathan V. Nguyen, Carlos M. Moran-Segura, Jasreman Dhillon, Philipp Altrock, Brandon J. Manley. Non-random spatial clustering of tumor associated macrophages is associated with poor survival in metastatic RCC patients receiving immunotherapy [abstract]. In: Proceedings of the AACR Virtual Special Conference on Tumor Heterogeneity: From Single Cells to Clinical Impact; 2020 Sep 17-18. Philadelphia (PA): AACR; Cancer Res 2020;80(21 Suppl):Abstract nr PO-034.
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