
Abstract Chemotherapy is ubiquitous in first-line treatment of advanced gastric cancer, yet responses are heterogeneous, and little is known about mediators of chemotherapy response. To move forward, an understanding of the effects of standard chemotherapy on the tumor–immune microenvironment (TME) is needed. Coupling whole-exome sequencing, bulk RNA and single-cell transcriptomics from paired pretreatment and on-treatment samples in treatment-naïve patients with HER2-positive and HER2-negative gastric cancer, we define features associated with response to platinum-based chemotherapy. Response was associated with on-treatment TME remodeling including natural killer (NK) cell recruitment, decreased tumor-associated macrophages, M1-macrophage repolarization, and increased effector T-cell infiltration. Among chemotherapy nonresponders, we observed low/absent PD-L1 expression or modulation, on-treatment increases in Wnt signaling, B-cell infiltration, and LAG3-expressing T cells coupled to an exodus of dendritic cells. We did not observe significant genomic changes in early on-treatment sampling. We provide a map of on-treatment TME modulation with standard chemotherapy and nominate candidate future approaches. Significance: Using paired pretreatment and on-treatment samples during standard first-line chemotherapy, we identify chemotherapy-induced NK-cell infiltration, macrophage repolarization, and increased antigen presentation among responders. Increased LAG3 expression and decreased dendritic cell abundance were seen in nonresponders, emphasizing remodeling of the TME during chemotherapy response and resistance. This article is highlighted in the In This Issue feature, p. 873
Platinum / pharmacology, 610, Genomics, Stomach Neoplasms* / drug therapy, Stomach Neoplasms, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Antineoplastic Combined Chemotherapy Protocols, Tumor Microenvironment, Humans, Antineoplastic Combined Chemotherapy Protocols / pharmacology, Platinum / therapeutic use, Stomach Neoplasms* / genetics, Research Articles, Platinum
Platinum / pharmacology, 610, Genomics, Stomach Neoplasms* / drug therapy, Stomach Neoplasms, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Antineoplastic Combined Chemotherapy Protocols, Tumor Microenvironment, Humans, Antineoplastic Combined Chemotherapy Protocols / pharmacology, Platinum / therapeutic use, Stomach Neoplasms* / genetics, Research Articles, Platinum
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| popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 1% | |
| influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Top 10% | |
| impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 1% |
