Pan-cancer prediction of tumor immune activation and response to immune checkpoint blockade from tumor transcriptomics and histopathology

Abstract

Accurately predicting which patients will respond to immune checkpoint blockade (ICB) remains a major challenge. Here, we present TIME_ACT, an unsupervised 66-gene transcriptomic signature of tumor immune activation derived from TCGA (The Cancer Genome Atlas) melanoma data. First, we demonstrate that TIME_ACT scores accurately identify tumors with activated immune microenvironments across different cancer types. Further, analysis of spatial features reveals that tumor microenvironment regions with dense lymphocyte infiltration near tumor cells have high TIME_ACT scores, successfully marking localized immune activation. Second, across 25 transcriptomic ICB cohorts encompassing nine cancer types, TIME_ACT achieves a mean AUC of 0.76 and a mean odds ratio of 5.77, significantly outperforming 30 established transcriptomic signatures and prediction methods for ICB response, including a recently developed foundation model for immunotherapy response prediction. Third, we show that TIME_ACT scores can be accurately inferred from routine tumor histopathology slides and that slide-inferred TIME_ACT scores predict ICB response across nine new independent patient cohorts spanning eight cancer types, achieving a mean AUC of 0.72 and a mean odds ratio of 4.99. These findings establish TIME_ACT as a robust, pan-cancer biomarker that enables accurate, low-cost, and clinically scalable prediction of ICB response from routine histopathology.