IMMUNOSCORE® COLON Advanced Tumor Immune Microenvironment Analysis

for unmatched clinical perfomance in routine settings

With Immunoscore® Colon, HalioDx will provide to clinicians a unique and robust decision making tool for patients management based on intra-tumor immune response.

Immunoscore® Colon, the first standardized immune-based assay for the classification of cancer, is available through HalioDx service laboratory*.

By the end of the year, pathologists will have access to a CE-IVD assay in Europe, while a RUO (Research Use Only) solution will also be available in the rest of the World.

* This test is intended for Research Use Only. Not for use in diagnostic procedures.


Immunoscore® Colon
Indication: Colon Cancer 
Clinical Utility*: Improve the classification of cancer & identifying patients at high risk of recurrence
Material: FFPE slides from tumor resection
Target: CD3+ & CD8+ T-cells
Location: Centre and periphery of the tumor 
Technology: Digital Pathology enhanced Immunochistochemistry
  • Immunoscore® Colon measures the density of two T lymphocyte populations in the center and at the periphery of the tumor: CD3+ and CD8+ T cells. The CE-IVD test will provide a better staging of the disease and improve clinical decision-making process for colon cancer patients.
  • The technology used is immuno-histochemistry coupled to advanced Immunoscore® Analyzer for a standardized tissue segmentation and immune cells quantification. Cell densities are then computed to provide the sample’s Immunoscore®.
  • Immunoscore® Colon under its CE-IVD version is one of the first diagnostic tests that will be used in routine by pathology labs leveraging advanced image analysis. The accuracy and robustness of the test relies on precise counting of positive immune cells in predefined regions and automatic calculation of Immunoscore® for each patient based on specific algorithm.


* Refer to Ordering Information part.


About Colon cancer (CC):

  • Cancers of the colon and the rectum altogether are the third most common cancer in men and the second in women worldwide. In 2014, 1.4 million new cases of colorectal cancer were diagnosed worldwide, and nearly 700,000 patients died of the disease (Classification of malignant tumors 7th edition, UICC). About 72% of cases arise in the colon and about 28% in the rectum.
  • Today, the TNM staging system (AJCC/UICC) provides the most reliable reference for the routine prognostication and treatment decision for colorectal carcinoma. TNM system describes tumour extension in the primary tumour (T), in the regional lymph nodes (N) and indicates the presence of metastases in distant organs (M).
  • In daily practice and in guidelines, TNM categories are directly linked to treatment strategies and, as such, changes in the TNM staging system have a considerable and direct impact on the cancer care that patients receive. Treatment for colon cancer may involve surgery, chemotherapy/biological therapy or radiation therapy in combination.

Medical Needs :

  • The survival rate at five years is largely correlated with disease stages but in stages II and III, representing almost half of new cases of colon cancers, there is still debates on how to improve adjuvant treatment decisions. The 7th edition of the AJCC TNM system was issued in 2010 to address this issue but still provides incomplete prognostic information (1).
  • In some patients, advanced-stage cancer can remain stable for years, and although rare, partial or full regression of metastatic tumours can occur spontaneously (2). In contrast, relapse, rapid tumour progression and patient death is associated with approximately 20% of TNM II stage colorectal cancer (CRC) patients, despite complete surgical resection and no evidence of residual tumour burden or distant metastasis (2). The challenge is to identify those patients in whom disease will recur.
  • Extensive literature has documented the host immune response against cancer and demonstrated the prognostic impact of the in situ immune cell infiltrate in tumours. The Immunoscore®, which quantifies CD3+ and CD8+ T-cells infiltrates both in the tumor core and in the invasive margin, has been shown to have a significant prognostic value in several cancers.
  • In CRC, it has been demonstrated to significantly improve prognostic accuracy independently of clinical variables for all patients with CRC stages I/II/III (3, 4, 5), and to have superior prognostic power versus the classical TNM staging system.  By evaluating the immune contexture of the tumor, the Immunoscore® Colon assay is aimed at providing a better staging of the disease, hence, an improved clinical decision-making process for colon cancer patients.

A number of studies have been conducted to establish clinical performance of the test. The main objective is  to demonstrate how the Immunoscore® could support safe clinical decision making in colon cancer.

A major study has been conducted by the Immunoscore® worldwide consortium, led by the Society for Immunotherapy of Cancer (SITC) involving 23 pathology centers from 17 countries and including more than 3,800 stage I-III colon cancer patients. See press release

Results have been presented at ASCO 2016 by Dr Jérôme GALON, Research Director at Inserm, Head of the laboratory of Integrative Cancer Immunology, Paris, France and principal investigator of the study

Visit ASCO Media library - reserved access


This study validates Immunoscore® Colon as a prognostic marker in stage I/II/III colon cancer.

SITC study key results:

  • Immunoscore® Colon predicted Time To Recurrence (TTR): primary end-point of the study
  • Immunoscore® Colon also predicted Disease Free Survival (DFS) and Overall Survival (OS)
  • Immunoscore® Colon was statistically significant in multivariate models including TNM stage
  • Immunoscore® classification identified a subgroup of high-risk stage II patients that could potentially benefit from adjuvant chemotherapy (n=375 high-risk patients out of 1433 Stage II) (HR (95% CI), .36 (.23-.56), p<.0001)
  • Immunoscore® Colon is robust and reproducible across centers

Jérôme GALON underlined: “In the era of oncology, notably in immunotherapy, it is now essential to classify cancer patients based on immune parameters. The results of this study conducted by an international consortium has the potential to drive the implementation of the Immunoscore® as a new component for the classification of cancer, designated as TNM-I (TNM-Immune)”.


Immunoscore® compared to Microsatellite status

In another recent study led by Jerome Galon’s team, published in Immunity, the researchers analyzed tumors from TCGA and INSERM cohorts of colorectal cancer in order to understand the impact of tumor instability on patient survival. They performed comprehensive analysis and described the genetic, genomic, and immune landscape in microsatellite-instable tumors. Survival analysis and multivariate analysis of the INSERM cohort revealed that Immunoscore® was superior to microsatellite instability in predicting patients’ disease-specific recurrence and survival.

Immunoscore® is a stronger predictor of survival than MSI


As illustrated below, survival analysis showed that patients with high immune infiltrate (IS 3 and IS 4) have a significant prolonged DSS regardless of their Microsatellite status.

Similar results were found for OS (overall survival) and DFS (disease free survival). MSI patients with a low Immunoscore® IS 0, 1 or 2 (black curve) show a very bad clinical outcome when MSS patients with a low Immunoscore® IS 0, 1 or 2 (blue curve) show a similarly bad clinical outcome.

In multivariate analysis for DFS, DSS & OS, Immunoscore® is significant (p=0.0001) whereas histopathological parameters & MSI are not.

Depending on your laboratory equipment, Immunoscore® Colon* is available in a full service process (performed in HalioDx laboratories) or through a standardized and validated workflow including Immunoscore® Colon Research Use Only in which you will perform Immuno-histochemistry step and send stained slides or images to HalioDx Service Laboratory for image analysis and result reporting. 

By the end of the year, pathologists will have access to a CE-IVD assay in Europe, while a RUO (Research Use Only) solution will also be available in the rest of the World.

Interested in ordering Immunoscore® Colon ?

Please download documentation (here in the right column) and contact us : lab.service(at)haliodx(dot)com

* This test is intended for Research Use Only. Not for use in diagnostic procedures.

For academic centers who would like to set up collaborations with HalioDx using Immunoscore® Colon, please contact us using the form below. We will be happy to contact you in return to discuss your project.

Reference publications

Immunoscore® & Immunoscore® Colon

Kirilovsky A et al.

Rational bases for the use of the Immunoscore in routine clinical settings as a prognostic and predictive biomarker in cancer patients

Int Immunol. 2016

doi: 10.1093/intimm/dxw021

More info

Hermitte F.

Biomarkers immune monitoring technology primer: Immunoscore® Colon

Journal for ImmunoTherapy of Cancer 2016

DOI: 10.1186/s40425-016-0161-x

More info

Mlecnik B et al.

Integrative Analyses of Colorectal Cancer Show Immunoscore Is a Stronger Predictor of Patient Survival Than Microsatellite Instability.

Immunity. 2016 ;

Mar 15;44(3):698-711.

More info

Mlecnik B et al.

The tumor microenvironment and Immunoscore are critical determinants of dissemination to distant metastasis.

Sci Transl Med. 2016 ;

24 Feb 2016, Vol. 8, Issue 327, pp. 327ra26.

More info

Galon J et al.

Towards the introduction of the 'Immunoscore' in the classification of malignant tumours

J Pathol. 2014


More info

Galon J et al.

Cancer classification using the Immunoscore: a worldwide task force.

J Transl Med 2012 ;

10 : 205.

More info

Mlecnik B et al.

Histopathologic-based prognostic factors of colorectal cancers are associated with the state of the local immune reaction.

J Clin Oncol 2011 ;

29 : 610-8.

More info

Pages F al.

In situ cytotoxic and memory T cells predict outcome in patients with early-stage colorectal cancer.

J Clin Oncol 2009 ;

27 : 5944-51.

More info

Galon J et al.

Type, density, and location of immune cells within human colorectal tumors predict clinical outcome.

Science 2006 ;

313 : 1960-4.

More info

Onclive TV coverage at ASCO 2016

Jerome Galon on the Prognostic Value of Immunoscore®