There is an urgent need for predictive platforms for response to immunotherapy in patients. In vivo phenotyping of tumor-immune microenvironment (TiME) for predicting response to immunotherapy was evaluated using non-invasive reflectance confocal microscopy (RCM) in skin cancer patients. Phenotypes were correlated with underlying biology and response to topical immunotherapy. Using both inflammation and vasculature features, four major phenotypes were observed. The VaschiInfhi phenotype correlated with high immune activation, exhaustion, and vascular signatures while VaschiInflo with endothelial anergy and immune exclusion. Highest response to immunotherapy was seen in VascloInfhi phenotype. This study establishes proof-of-concept for in vivo TiME phenotyping in patients.
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