Features of the intratumoral T cell receptor repertoire associated with antigen exposure in cancer patients

The clinical success of immunotherapies demonstrates the importance of the immune system in tumour control, but the response rates remain low and many biological mechanisms underlying how these therapies work are still uncharacterised. In particular, the specificity of the anti-tumour immune response pre-existing in treatment-naive patients or induced by treatment remains poorly described. In this thesis, I explore how T cell receptor (TCR) sequencing data in multi-omics contexts can be utilised to identify features associated with antigen exposure in cancer patients. In treatment-naive non-small cell lung cancer (NSCLC) patients, multi-region TCR sequencing revealed a pattern of heterogeneity in the TCR repertoire resembling the heterogeneity observed in the mutational profile of these tumours and a range of clonotype frequency values associated with tumour specificity. A novel method was built in order to identify distinct TCR populations that spatially follow the pattern of the well-established clonal/subclonal mutational dichotomy. The impact of immune checkpoint blockade therapy on the TCR repertoire distribution was assessed in advanced renal cell carcinoma in the context of anti- PD1 treatment. TCRs with frequency distribution characteristics similar to what was observed in NSCLC were maintained upon treatment and associated with clinical response. In addition, RNA-sequencing analysis identified a gene expression profile consistent with specific activation of T cells through TCR signalling. Finally, the same methodology was applied to bone marrow samples harvested from B cell acute lymphoblastic leukaemia (B-ALL) patients. A statistical framework was developed in order to efficiently distinguish leukaemic re-arrangements from the non- leukaemic TCR repertoire of B-ALL patients. Subsequently, longitudinal analysis revealed TCR distributions that suggested the presence of cytotoxic T cells which was further characterised in matched single-cell RNA sequencing data