Enhanced prediction of breast cancer patient response to chemotherapy by integrating deconvolved expression patterns of immune, stromal and tumor cells.

The tumor microenvironment (TME) is a complex ecosystem of diverse cell types whose interactions govern tumor growth and clinical outcome. While multiple studies have extensively charted the TME's impact on immunotherapy, its role in chemotherapy response remains less explored. To address this, we developed DECODEM (DEcoupling Cell-type-specific Outcomes using DEconvolution and Machine learning), a generic computational framework leveraging cellular deconvolution of bulk transcriptomics to associate gene expression of individual cell types in the TME with clinical response. Employing DECODEM to analyze gene expression of breast cancer patients treated with neoadjuvant chemotherapy across three bulk cohorts, we find that the expression of specific immune cells (myeloid, plasmablasts, B-cells) and stromal cells (endothelial, normal epithelial, CAFs) are highly predictive of chemotherapy response, achieving the same performance levels as the expression of malignant cells. Notably, ensemble models integrating the estimated expression of different cell types perform the best and outperform models built on the original tumor bulk expression. These findings and model generalizability are further tested and validated using two single-cell (SC) cohorts of triple negative breast cancer. To investigate the possible role of immune cell-cell interactions (CCIs) in mediating chemotherapy response, we extended DECODEM to DECODEMi to identify such key functionally important CCIs, validated in SC data. Our findings highlight the importance of active pre-treatment immune infiltration for chemotherapy success. DECODEM and DECODEMi are made publicly available to facilitate studying the role of the TME in mediating response in a wide range of cancer indications and treatments.