PURPOSE: Cancer-associated fibroblasts (CAF) have been implicated as potential mediators of checkpoint immunotherapy response. However, the extensive heterogeneity of these cells has precluded rigorous understanding of their immunoregulatory role in the tumor microenvironment. EXPERIMENTAL DESIGN: We performed high dimensional single-cell RNA sequencing (scRNA-Seq) on four patient tumors pre- and post-treatment from a neoadjuvant trial of advanced-stage head and neck squamous cell carcinoma (HNSCC) patients that were treated with the aPD-1 therapy, nivolumab. The head and neck CAF (HNCAF) protein activity profiles, derived from this cohort of paired scRNA-Seq, were used to perform protein activity enrichment analysis on the 28-patient parental cohort of clinically annotated bulk transcriptomic profiles. Ex vivo coculture assays were used to test functional relevance of HNCAF subtypes. RESULTS: Fourteen distinct cell types were identified with the fibroblast population showing significant changes in abundance following nivolumab treatment. Among the fibroblast subtypes, HNCAF-0/3 emerged as predictive of nivolumab response, while HNCAF-1 was associated with immunosuppression. Functionally, HNCAF-0/3 were found to reduce TGF_-dependent PD-1+TIM-3+ exhaustion of CD8 T cells, increase CD103+NKG2A+ resident memory phenotypes, and enhance the overall cytolytic profile of T cells. CONCLUSIONS: Our findings demonstrate the functional importance of distinct HNCAF subsets in modulating the immunoregulatory milieu of human HNSCC. Additionally, we have identified clinically actionable HNCAF subtypes that can be used as a biomarker of response and resistance in future clinical trials.

Author Info: (1) Columbia University Medical Center, New York, NY, United States. (2) Vanderbilt University, Nashville, United States. (3) Vanderbilt University Medical Center, Nashville, TN, U nited States. (4) Vanderbilt University Medical Center, Nashville, Tennessee, United States. (5) Vanderbilt University Medical Center, United States. (6) Vanderbilt University Medical Center, Nashville, United States. (7) Vanderbilt University Medical Center, Nashville, TN, United States. (8) Thomas Jefferson University, Philadelphia, PA, United States. (9) Thomas Jefferson University, Philadelphia, PA, United States. (10) Vanderbilt-Ingram Cancer Center, Nashville, TN, United States. (11) Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, United States. (12) Vanderbilt University Medical Center, Nashville, United States. (13) National Cancer Institute, Bethesda, MD, United States. (14) Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA, United States. (15) Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, United States. (16) Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, United States. (17) Columbia University, New York, NY, United States. (18) Regeneron Pharmaceuticals, Tarrytown, United States.