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Nivolumab belongs to the standard therapy in the second‐line setting of metastatic renal cell carcinoma ( mRCC ). Although deep and long‐lasting responses are seen in some patients, the majority of patients will further progress.  PD ‐L1 is still under critical evaluation as a predictive biomarker. Thus, more accurate biomarkers are clearly warranted. Here, we investigated for the first time the predictive role of  IDO ‐1, a negative immune‐regulatory molecule, on clear cell  RCC  tissues of 15 patients undergoing nivolumab therapy.  IDO ‐1 and other immune inhibitory molecules ( PD ‐L1,  PD ‐L2,  FOXP 3) as well as immune cell subsets ( CD 3,  CD 4 and  CD 8) were measured on formalin‐fixed, paraffin‐embedded sections of  RCC  specimens by immunohistochemistry.  IDO ‐1 was predominantly expressed in tumor endothelial cells, and was totally absent from tumor cells itself.  IDO ‐1 overexpression (>10%) could be detected more frequently in responders (100%, n = 6/6) compared to non‐responders (33.3%, n = 3/9;  P  = .028), resulting in a better progression‐free survival during immunotherapy ( IDO ‐1 ≤ 10% vs >10%, median: 3.5 vs not estimated (NE) months,  P  = .01 by log‐rank test). In addition,  IDO ‐1 was positively correlated with  CD 8 +  T cell expression ( r  s  = .691,  P  = .006).  PD ‐L1 expression on tumor cells was negative in 13 (86.7%) of 15 patients, irrespective of therapeutic response (responders vs non‐responders: 83.3% vs 88.9%). No differences were noticed in the  PD ‐L1 expression on tumor‐infiltrating immune cells ( PD ‐L1 < 1% in 66.7% of both responders and non‐responders). In contrast to  PD ‐L1, these results suggest that  IDO ‐1 may be a more promising predictive biomarker for response to immune‐based cancer therapy in  mRCC .

High IDO ‐1 expression in tumor endothelial cells is associated with response to immunotherapy in metastatic renal cell carcinoma