Joseph R. Broucek, Eileena F. Giurini, Nora L. Herzog, Lisa K. Denzin, Gabriel Guevara-Aleman, C. Brent Chesson, Ricardo Estupinian, Marco Rossi, Mary J. Fidler, Raquel E. Redondo, Jai S. Rudra, Joyce Paras, Jochen Reiser, Amanda L. Marzo, Jyoti Malhotra, Shang Jui Wang, Emily S. Ruiz, Stuti Buddhadev, Howard L. Kaufman, Saeed Tarabichi, Sachin R. Jhawar, Frederick J. Kohlhapp, Daniel J. Medina, Mones M. Aboelatta, David Rotter, Shengguo Li, Leonard Y. Lee, Vineet Gupta, John Langenfeld, Ann W. Silk, Russell J. Pepe, Kajal Gupta, Timothy M. Kuzel, Jason M. Schenkel, Derek B. Sant'Angelo, Abdulkareem Abed, Jenna H. Newman, Michael J. Lee, Praveen K. Bommareddy, Salvatore M. Aspromonte, Ahmed Lasfar, Eric A. Singer, Michael P. Kane, Christina Nowicki, Arnold B. Rabson, Andrew Zloza, Paul G. Thomas, and Josef W. Goldufsky
Significance Immunotherapy has revolutionized cancer treatment, yielding unprecedented long-term responses and survival. However, a significant proportion of patients remain refractory, which correlates with the absence of immune-infiltrated (“hot”) tumors. Here, we observed that FDA-approved unadjuvanted seasonal influenza vaccines administered via intratumoral injection not only provide protection against active influenza virus lung infection, but also reduce tumor growth by increasing antitumor CD8+ T cells and decreasing regulatory B cells within the tumor. Ultimately, intratumoral unadjuvanted seasonal influenza vaccine converts immunologically inactive “cold” tumors to “hot,” generates systemic responses, and sensitizes resistant tumors to checkpoint blockade. Repurposing the “flu shot” may increase response rates to immunotherapy, and based on its current FDA approval and safety profile, may be quickly translated for clinical care., Reprogramming the tumor microenvironment to increase immune-mediated responses is currently of intense interest. Patients with immune-infiltrated “hot” tumors demonstrate higher treatment response rates and improved survival. However, only the minority of tumors are hot, and a limited proportion of patients benefit from immunotherapies. Innovative approaches that make tumors hot can have immediate impact particularly if they repurpose drugs with additional cancer-unrelated benefits. The seasonal influenza vaccine is recommended for all persons over 6 mo without prohibitive contraindications, including most cancer patients. Here, we report that unadjuvanted seasonal influenza vaccination via intratumoral, but not intramuscular, injection converts “cold” tumors to hot, generates systemic CD8+ T cell-mediated antitumor immunity, and sensitizes resistant tumors to checkpoint blockade. Importantly, intratumoral vaccination also provides protection against subsequent active influenza virus lung infection. Surprisingly, a squalene-based adjuvanted vaccine maintains intratumoral regulatory B cells and fails to improve antitumor responses, even while protecting against active influenza virus lung infection. Adjuvant removal, B cell depletion, or IL-10 blockade recovers its antitumor effectiveness. Our findings propose that antipathogen vaccines may be utilized for both infection prevention and repurposing as a cancer immunotherapy.