The Immunoscore assay can assess the risk of recurrance in early stage colon cancer and may be used together with TNM classification to guide clinical decision-making, according to findings presented at the ESMO Asia Virtual Congress 2020, held 20 to 22 November 2020.
Jérôme Galon of the Cordeliers Research Center, INSERM team 15, Laboratory of Integrative Cancer Immunology in Paris, France, reported how Immunoscore, an in vitro diagnostic test, may be used to predict the risk of relapse in early‐stage colon cancer by measuring the patient’s immune response at the tumour site. He explained that the risk‐assessment tool has been shown to provide independent prognostic value that is superior to the usual risk parametres and is intended for use as an adjunct to the TNM classification for clinical decision.
Professor Galon and colleagues conducted this study to evaluate the clinical performance of Immunoscore in an Asian population using data from the Society for Immunotherapy of Cancer (SITC)-led validation study, wherein 423 patients of the 2681 eligible stage I-III patients enrolled in the international Immunoscore study1 were recruited from 4 expert centres. Specifically, 330 patients were enrolled from Japan, 35 from China, and 58 patients were from India.
The investigators compared the time to recurrence (TTR) according to Immunoscore categories. Patient classification by Immunoscore (IS) was done using pre-defined cut-offs: IS Low (IS 0-1) and IS High (IS 2-4).
A significant positive association was found between Immunoscore and TTR in the Asian subgroup that was consistent with data from the entire study population
In the Asian cohort, 158 (37%) patients were categorised as Immunoscore Low and and 266 (63%) were categorised as Immunoscore High.
At 5 years, 86.9% (95% confidence interval [CI] 82.7-91.4), of Immunoscore High patients were event-free compared to 77% (95% CI 70,5-84,1) of Immunoscore Low patients (hazard ratio [HR] 0.52; 95% CI 0.32-0.86; p = 0.0085).
Furthermore, with model adjustments including Immunoscore, age, gender, T-stage, N-stage, sidedness and micro-sattelite instability (MSI), and stratification by centre, Immunoscore maintained this asociation (HR 0.45; 95% CI 0.22-0.91; p = 0.027). When stratified according to the 5 Immunoscore categories (high to low), the 5-year TTR rates were 100%, 96%, 84%, 80%, and 73.5% for IS4, IS3, IS2, IS1, IS0, respectively.
Conclusions
The authors noted that these results were similar to those found in European and North American patients.
They further concluded that Immunoscore is a strong prognostic indicator of the risk of recurrence in stage I-III colon cancer patients who receive standard of care treatment in real-life clinical practice in Asia, and suggest that this first standardised immune-based assay risk assessment tool can be used reliably to guide clinical decision according to each patient’s information.
The prognostic value of Immunoscore and its predictive value of response to chemotherapy has been shown in multiple published studies. Immunoscore is also associated with time to recurrence and overall survival in the Asian population. The clinical utility of Immunoscore has been demonstrated and Immunoscore has been included into the WHO digestive cancer classification and into the ESMO clinical guidelines for gastrointestinal tumours in 2020. It has not yet been included into Asian and Japanese guidelines.
© Jérôme Galon.
This study was funded by the French National Institute of Health and Medical Research (INSERM), the LabEx Immuno-oncology, the Transcan ERAnet Immunoscore European project, Association pour la Recherche contre le Cancer, CARPEM, AP-HP, Institut National du Cancer, Italian Association for Cancer Research, national grants and the SITC. Immunoscore® is a registered trademark from the INSERM licensed to HalioDx.
Citation
- Pagès F, et al. The Lancet 2018;391(10135):2128-2139.
Reference
79O – Galon J, Kawakami Y, Torigoe T, et al. Clinical performance of Immunoscore in early colon cancer in the Asian population. ESMO Asia Virtual Congress 2020 (20-22 November).