Dynamic Tumor Immune Microenvironment Remodeling Predicts Response of Checkpoint Inhibitor Therapy

Abstract Immune checkpoint inhibitors (ICI) have transformed cancer therapy, yet the basis of variable patient responses remains unclear. We assembled a longitudinal single-cell RNA sequencing atlas of 441 samples from 241 patients across ten cancers to map treatment-associated remodeling of the tumor immune microenvironment (TIME). Using a hierarchical reference-guided deep-phenotyping framework, we defined 77 immune and stromal subtypes and resolved four conserved TIME subtypes. Approximately 40% of tumors shifted between states during therapy, and the transition was more predictive of outcome than the baseline state. Across 1,988 bulk transcriptomic tumors, favorable transitions toward inflamed or B-cell-enriched subtype tracked with improved response and survival, while persistence in or shifts towards myeloid dominance indicated resistance. We derived a transition score that predicted outcomes for baseline tumors across independent cohorts. These findings establish immunotype transitions as a central determinant of ICI, offering new avenues for response prediction and rational immunotherapy design. Highlights A pan-cancer meta-analysis maps treatment-associated remodeling of the tumor immune microenvironment. Four conserved TIME states emerge across cancer subtypes. TIME transition patterns during treatment are associated with clinical outcome. Baseline immune programs derived transition scores predict treatment response and survival.