The T Cell Immunoscore as a Reference for Biomarker Development Utilizing Real-World Data from Patients with Advanced Malignancies Treated with Immune Checkpoint Inhibitors †

SIMPLE SUMMARY: This study utilized real-world data from patients with advanced malignancies who underwent immune checkpoint inhibitor (ICI) treatment. We used transcriptomic data to derive an immunoscore based on CD3+ and CD8+ T cell densities using CIBERSORTx and the LM22 gene signature matrix. The imputed immunoscore effectively predicted overall survival (OS); patients with an intermediate–high immunoscore achieved better OS than those with a low immunoscore. Therefore, the T cell immunoscore represents a promising signature for estimating OS with ICIs and can be used as a reference for future machine learning-based biomarker development. ABSTRACT: Background: We aimed to determine the prognostic value of an immunoscore reflecting CD3+ and CD8+ T cell density estimated from real-world transcriptomic data of a patient cohort with advanced malignancies treated with immune checkpoint inhibitors (ICIs) in an effort to validate a reference for future machine learning-based biomarker development. Methods: Transcriptomic data was collected under the Total Cancer Care Protocol (NCT03977402) Avatar(®) project. The real-world immunoscore for each patient was calculated based on the estimated densities of tumor CD3+ and CD8+ T cells utilizing CIBERSORTx and the LM22 gene signature matrix. Then, the immunoscore association with overall survival (OS) was estimated using Cox regression and analyzed using Kaplan–Meier curves. The OS predictions were assessed using Harrell’s concordance index (C-index). The Youden index was used to identify the optimal cut-off point. Statistical significance was assessed using the log-rank test. Results: Our study encompassed 522 patients with four cancer types. The median duration to death was 10.5 months for the 275 participants who encountered an event. For the entire cohort, the results demonstrated that transcriptomics-based immunoscore could significantly predict patients at risk of death (p-value < 0.001). Notably, patients with an intermediate–high immunoscore achieved better OS than those with a low immunoscore. In subgroup analysis, the prediction of OS was significant for melanoma and head and neck cancer patients but did not reach significance in the non-small cell lung cancer or renal cell carcinoma cohorts. Conclusions: Calculating CD3+ and CD8+ T cell immunoscore using real-world transcriptomic data represents a promising signature for estimating OS with ICIs and can be used as a reference for future machine learning-based biomarker development.