Tumor-immune trajectory context connects static tissue architecture to clinical outcomes

Abstract Multiplexed tissue imaging (MTI) has revealed recurrent tumor microenvironment (TME) architectures with prognostic value, yet these measurements are inherently static, obscuring dynamic changes in the TME that govern therapeutic response. Here, we introduce a trajectory-centric framework that reconstructs continuous TME dynamics by integrating agent-based mathematical modeling and simulation with state space analysis. This approach yields a mechanistically constrained reference landscape built entirely from in silico simulation, and onto which static patient biospecimens can be projected and mapped onto simulated TME trajectories. Systematic simulation of tumor-immune interactions in triple-negative breast cancer identifies six metastable TME states connected by transition pathways spanning immune control to immune escape. Mapping MTI data from two independent patient cohorts, including longitudinal samples from a randomized immunotherapy trial, validates this landscape by positioning individual biospecimens along inferred TME trajectories rather than in static states. We show that treatment-phase TME states, but not pre-treatment configurations, robustly predict immunotherapy response, and identical terminal states can arise from distinct trajectory histories corresponding to immune failure or resolved inflammation. Thus, this framework enables mechanistic simulations to define a reference dynamical landscape that serves as a coordinate system for interpreting static clinical spatial data, providing a principled basis for evaluating consistency, predictiveness, and clinical relevance across independent patient cohorts. Altogether, this study advances spatial tumor profiling from static state classification of human tissues to dynamic trajectory inference, establishing a quantitative framework for trajectory-informed, state-guided, and temporally adaptive immunotherapy strategies.