Immune-active microenvironment in small cell carcinoma of the ovary, hypercalcemic type: rationale for immune checkpoint blockade

Abstract

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a highly aggressive monogenic cancer driven by SMARCA4 mutations. Here, we report responses to anti-PD1 immunotherapy in four patients and characterize the immune landscape of SCCOHT tumors using quantitative immunofluorescence and gene expression profiling. Unexpectedly for a low mutation burden cancer, the majority of the tumors demonstrated PD-L1 expression with strong associated T cell infiltration. PD-L1 expression was detected in both tumor and stromal cells, with macrophages being the most abundant PD-L1 positive cells in some tumors. Transcriptional profiling revealed increased expression of genes related to Th1 and cytotoxic cell function in PD-L1 high tumors, suggesting that PD-L1 acts as a pathway of adaptive immune resistance in SCCOHT. These findings suggest that although SCCOHT are low-mutational-burden tumors, their immunogenic microenvironment that resembles the landscape of tumors that respond well to treatment with PD-1/PD-L1 blockade.