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IDO expression in breast cancer: an assessment of 281 primary and metastatic cases with comparison to PD-L1

Modern Pathologyvolume 31pages15131522 (2018) | Download Citation

Abstract

The immune inhibitory enzyme indoleamine 2,3-dioxygenase (IDO) has been associated with immune evasion in numerous malignancies and may mark these cancers as susceptible to anti-IDO therapies. We herein address IDO expression in breast cancers, examine the relationship between IDO and PD-L1, and investigate IDO fidelity across breast cancer primaries and metastases. IDO and PD-L1 expression was assessed in tissue microarrays containing 242 invasive primary breast cancers, 20 nodal metastases, and 19 distant metastases. IDO and PD-L1 were scored by extent in the tumor cells and immune infiltrate. Tumor IDO staining was seen in 14% of primaries including 38% of triple-negative cancers. IDO immune cell staining was seen in 14% of primaries and 29% of triple-negative cancers. Tumoral IDO and PD-L1 co-expression was seen in 8% of primaries, including 70% of tumoral PD-L1-positive cases. Immune IDO and PD-L1 co-expression was identified in 14% of primaries, including 48% of immune PD-L1-positive cases. Tumoral and immune cell IDO was conserved in 94% of matched primary/metastasis. In summary, IDO expression is common among high-grade, triple-negative breast cancers and is frequently associated with PD-L1 co-expression, suggesting that IDO might be a mechanism of anti-PD-1/PD-L1 immunotherapy resistance and that dual therapy may be of utility. Tumoral and immune cell IDO expression shows fidelity between primary and metastatic sites in treatment-naïve cancers, arguing against IDO as an independent driver for metastatic spread. Clinical trials are needed to assess the efficacy of IDO inhibition relative to IDO expression, as well as its possible role in combination with anti-PD-1/PD-L1 immunotherapy.

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Acknowledgements

The authors would like to acknowledge the skill and expertise of the University of Virginia Biorepository and Tissue Research Facility in the construction of Tumor Microarrays.

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Affiliations

  1. University of Virginia Department of Pathology, Charlottesville, Virginia, USA

    • Erik A. Dill
    • , Timothy N. Bullock
    •  & Anne M. Mills
  2. University of Virginia Department of Medicine, Division of Hematology & Oncology, Charlottesville, Virginia, USA

    • Patrick M. Dillon

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Conflict of interest

towards increased tumoral expressioPMD participates in trials sponsored by BMS, Pfizer, Lilly, Merck, Newlink, Abb-vie, Novartis, Seattle Genetics and Genentech.The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Anne M. Mills.

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DOI

https://doi.org/10.1038/s41379-018-0061-3