AI-based morphologic model for prediction of individual patient response to immune checkpoint inhibitors for bladder cancer.

Authors

null

Monica Nair

Cleveland Clinic Lerner College of Medicine, Cleveland, OH

Monica Nair , Ross Liao , Parag Jain , Chensu Xie , Hassan Muhammad , Wei Huang , Hirak S Basu , George Wilding , Rajat Roy , C. Marcela Diaz-Montero , Tae Hyun Hwang , Scott Dawsey , Jane Nguyen , Eric A. Klein , Shilpa Gupta , Omar Y. Mian

Organizations

Cleveland Clinic Lerner College of Medicine, Cleveland, OH, Department of Urology, Cleveland Clinic, Cleveland, OH, PathomIQ Inc., Cupertino, CA, University of Wisconsin-Madison, Madison, WI, PathomIQ, Inc., Cupertino, CA, Cleveland Clinic Lerner Research Institute, Cleveland, OH, Mayo Clinic Florida, Jacksonville, FL, Cleveland Clinic, Cleveland, OH, Cleveland Clinic Foundation, Cleveland, OH, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH

Research Funding

Department of Defense
PathomIQ Inc

Background: Immune checkpoint inhibitors (ICI) have been used to treat advanced muscle invasive and/or metastatic bladder cancer. However, ICIs are only effective in 30-40% of cases. In light of potentially significant IRAE’s, tools to predict individual patient level benefits are desirable. AI technology offers the opportunity to apply computational methods to predict outcomes from readily available digitized pathology slides. We investigated the utility of an AI platform integrating computational biomarkers based on morphological characterization of digitized H&E slide whole images (WSI) to predict response to ICI. Methods: We analyzed H&E-stained whole slide images (WSI) of bladder tumor tissue collected from transurethral resection of bladder tumor (TURBT) from 116 patients with advanced or metastatic bladder cancer at a single institution between 2015-2020. Adjacent multiplex IHC stained specimens were analyzed myeloid and lymphoid marker panels. 20 patients from the overall cohort treated with ICI were designated ‘responders’ (complete response, partial response, stable disease) and 20 patients were identified as non-responders (progressive disease) based on ICI best clinical/radiographic response. WSIs were divided into small non-overlapping image patches. These image tiles were processed into multiple AI encoder models to extract morphological features. The tile morphological features, represented by high dimensional vectors, were combined by an aggregation model to represent the whole slide morphology and then used to classify the patients into responders vs non-responders to immunotherapy. Area-under-the-receiver operating characteristic (AUC) was used to measure the performance of response prediction. Results: Our method shows AUC of 0.708 at classification of the patients (n=40) into responder and non-responder groups. With a cutoff that identifies the top 50% patients (n=20) of high probability of responding to immunotherapy predicted by our models, 75% of them are responders. In the bottom 50% patients (n=20) of the low scores, 75% of them are non-responders. . Multiplex IHC (myeloid and lymphoid panel) was performed using adjacent sections and were characterized yielding deeper mechanistic insight into the inflammatory populations driving predictive morphologic patterns. Conclusions: By applying innovative AI morphological analysis on patient WSIs, we generated a computational biomarker that shows promising ability to predict patient response to immunotherapy in bladder cancer. This approach merits future prospective validation and additional patient level analysis in broader cohorts.

AUC 0.708Predicted
RespondersNon-responders
Ground TruthResponders75%25%
Non-responders25%75%

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Abstract Details

Meeting

2024 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Urothelial Carcinoma

Track

Urothelial Carcinoma

Sub Track

Translational Research, Tumor Biology, Biomarkers, and Pathology

Citation

J Clin Oncol 42, 2024 (suppl 4; abstr 686)

DOI

10.1200/JCO.2024.42.4_suppl.686

Abstract #

686

Poster Bd #

L8

Abstract Disclosures

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