TME-guided deep learning predicts chemotherapy and immunotherapy response in gastric cancer with attention-enhanced residual Swin Transformer

Adjuvant chemotherapy and immune checkpoint blockade exert quite durable anti-tumor responses, but the lack of effective biomarkers limits the therapeutic benefits. Utilizing multi-cohorts of 3,095 patients with gastric cancer, we propose an attention-enhanced residual Swin Transformer network to predict chemotherapy response (main task), and two predicting subtasks (ImmunoScore and periostin [POSTN]) are used as intermediate tasks to improve the model's performance. Furthermore, we assess whether the model can identify which patients would benefit from immunotherapy. The deep learning model achieves high accuracy in predicting chemotherapy response and the tumor microenvironment (ImmunoScore and POSTN). We further find that the model can identify which patient may benefit from checkpoint blockade immunotherapy. This approach offers precise chemotherapy and immunotherapy response predictions, opening avenues for personalized treatment options. Prospective studies are warranted to validate its clinical utility.