1. Intratumoral STING Activation with T-cell Checkpoint Modulation Generates Systemic Antitumor Immunity.
- Author
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Ager CR, Reilley MJ, Nicholas C, Bartkowiak T, Jaiswal AR, and Curran MA
- Subjects
- Animals, CD8-Positive T-Lymphocytes immunology, CTLA-4 Antigen antagonists & inhibitors, CTLA-4 Antigen immunology, Cell Line, Tumor, Cyclic GMP immunology, Dendritic Cells immunology, Humans, Immunotherapy, Membrane Proteins agonists, Mice, Neoplasms pathology, Neoplasms therapy, Programmed Cell Death 1 Receptor immunology, T-Lymphocytes immunology, Tumor Microenvironment immunology, Tumor Necrosis Factor Receptor Superfamily, Member 9 immunology, Lymphocytes, Tumor-Infiltrating immunology, Membrane Proteins immunology, Neoplasms immunology
- Abstract
Coordinated manipulation of independent immune regulatory pathways in the tumor microenvironment-including blockade of T-cell checkpoint receptors and reversal of suppressive myeloid programs-can render aggressive cancers susceptible to immune rejection. Elevated toxicity associated with combination immunotherapy, however, prevents translation of the most efficacious regimens. We evaluated T-cell checkpoint-modulating antibodies targeting CTLA-4, PD-1, and 4-1BB together with myeloid agonists targeting either STING or Flt3 in the TRAMP-C2 model of prostate cancer to determine whether low-dose intratumoral delivery of these agents could elicit systemic control of multifocal disease. Intratumoral administration of the STING agonist cyclic di-GMP (CDG) or Flt3 Ligand (Flt3L) augmented the therapeutic effect of systemic triple checkpoint modulation and promoted the cure of 75% of mice with bilateral TRAMP-C2; however, when all agents were administered locally, only CDG mobilized abscopal immunity. Combination efficacy correlated with globally enhanced ratios of CD8
+ T cells to regulatory T cells (Treg), macrophages, and myeloid-derived suppressor cells, and downregulation of the M2 marker CD206 on tumor-associated macrophages. Flt3L improved CD8+ T-cell and dendritic cell infiltration of tumors, but was diminished in efficacy by concomitant Treg expansion. Although intratumoral CDG/checkpoint therapy invokes substantial ulceration at the injection site, reduced CDG dosing can preserve tissue integrity without sacrificing therapeutic benefit. For high-order combinations of T-cell checkpoint antibodies and local myeloid agonists, systemic antibody administration provides the greatest efficacy; however, local administration of CDG and antibody provides substantial systemic benefit while minimizing the potential for immune-related adverse events. Cancer Immunol Res; 5(8); 676-84. ©2017 AACR ., (©2017 American Association for Cancer Research.)- Published
- 2017
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