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Molecular classification of microsatellite-instable colorectal cancers reveals distinct predictors of immunotherapy response
BGI Genom, Shenzhen, Peoples R China.
BGI Genom, Shenzhen, Peoples R China.
Chinese Acad Sci, Hangzhou Inst Med HIM, HIM BGI Omics Ctr, BGI Res, Hangzhou, Peoples R China; BGI Res, Guangdong Prov Key Lab Human Dis Genom, Shenzhen, Peoples R China.
Chinese Acad Sci, Hangzhou Inst Med HIM, HIM BGI Omics Ctr, BGI Res, Hangzhou, Peoples R China; BGI Res, Guangdong Prov Key Lab Human Dis Genom, Shenzhen, Peoples R China.
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2025 (English)In: ESMO Gastrointestinal Oncology, E-ISSN 2949-8198, Vol. 10, article id 100268Article in journal (Refereed) Published
Abstract [en]

Microsatellite-instable (MSI) tumours constitute one-fifth of colorectal cancers (CRCs). However, the MSI CRCs display substantial tumour microenvironment (TME) heterogeneity and variable responses to immunotherapy, necessitating a refined classification to guide personalized therapy. In this study, we analysed whole-genome and transcriptome sequences from 223 MSI CRC patients from a large prospective longitudinal cancer study in Sweden (Nunes L, Li F, Wu M, et al. Prognostic genome and transcriptome signatures in colorectal cancers. Nature. 2024;633(8028):137-146) and identified three molecular subclasses with distinct TME and genetic features: class 1a (immune-excluded), characterized by prominent stromal activation, transforming growth factor-ss signalling, and low tumour neoantigen burdens (TNB); class 1b (immune-infiltrated), marked by intact neoantigen presentation and strong antitumour immunity; and class 2 active metabolism, and a lack of immune activation. We further uncovered a correlation between mutL homolog 1 (MLH1) hypermethylation and the immune-cold phenotype in class 2, where anti-programmed cell death protein 1 (PD1) and anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4) combination immunotherapy demonstrated significantly improved efficacy compared with anti-PD-1 monotherapy. Finally, the molecular features of these subclasses were validated in external MSI CRC cohorts and in MSI tumours from other cancers. Our findings offer a comprehensive understanding of the molecular landscape of MSI CRC, unveiling potential molecular mechanisms underlying different tumour-immune phenotypes and laying the foundation for future development of tailored treatment strategies.

Place, publisher, year, edition, pages
Elsevier BV , 2025. Vol. 10, article id 100268
Keywords [en]
microsatellite instability, colorectal cancer, tumour microenvironment, immunotherapy, multi-omics analysis
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Cancer and Oncology
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URN: urn:nbn:se:kth:diva-376327DOI: 10.1016/j.esmogo.2025.100268ISI: 001626161100001Scopus ID: 2-s2.0-105022250349OAI: oai:DiVA.org:kth-376327DiVA, id: diva2:2038100
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QC 20260212

Available from: 2026-02-12 Created: 2026-02-12 Last updated: 2026-07-02Bibliographically approved

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Uhlén, Mathias

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