Department of Pathology, Duke University Medical Center, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
Clin Cancer Res. 2020 Mar 15;26(6):1349-1358. doi: 10.1158/1078-0432.CCR-19-1068. Epub 2019 Dec 23.
PURPOSE: The success of checkpoint blockade against glioblastoma (GBM) has been disappointing. Anti-PD-1 strategies may be hampered by severe T-cell exhaustion. We sought to develop a strategy that might license new efficacy for checkpoint blockade in GBM. EXPERIMENTAL DESIGN: We characterized 4-1BB expression in tumor-infiltrating lymphocytes (TIL) from human GBM. We implanted murine tumor models including glioma (CT2A), melanoma (B16), breast (E0771), and lung carcinomas intracranially and subcutaneously, characterized 4-1BB expression, and tested checkpoint blockade strategies . RESULTS: Our data reveal that 4-1BB is frequently present on nonexhausted CD8 TILs in human and murine GBM. In murine gliomas, 4-1BB agonism and PD-1 blockade demonstrate a synergistic survival benefit in a CD8 T-cell-dependent manner. The combination decreases TIL exhaustion and improves TIL functionality. This strategy proves most successful against intracranial CT2A gliomas. Efficacy in all instances correlates with the levels of 4-1BB expression on CD8 TILs, rather than with histology or with intracranial versus subcutaneous tumor location. Proffering 4-1BB expression to T cells licenses combination 4-1BB agonism and PD-1 blockade in models where TIL 4-1BB levels had previously been low and the treatment ineffective. CONCLUSIONS: Although poor T-cell activation and severe T-cell exhaustion appear to be limiting factors for checkpoint blockade in GBM, 4-1BB agonism obviates these limitations and produces long-term survival when combined with anti-PD-1 therapy. Furthermore, this combination therapy is limited by TIL 4-1BB expression, but not by the intracranial compartment, and therefore may be particularly well-suited to GBM.
目的:针对胶质母细胞瘤(GBM)的检查点阻断取得的成功令人失望。抗 PD-1 策略可能会受到严重 T 细胞耗竭的阻碍。我们试图开发一种策略,为 GBM 中的检查点阻断提供新的疗效。
实验设计:我们对来自人类 GBM 的肿瘤浸润淋巴细胞(TIL)中的 4-1BB 表达进行了特征分析。我们将包括神经胶质瘤(CT2A)、黑色素瘤(B16)、乳腺癌(E0771)和肺癌在内的小鼠肿瘤模型颅内和皮下植入,对 4-1BB 表达进行特征分析,并测试了检查点阻断策略。
结果:我们的数据表明,4-1BB 在人类和小鼠 GBM 的非耗竭性 CD8 TIL 上经常存在。在小鼠神经胶质瘤中,4-1BB 激动剂和 PD-1 阻断以 CD8 T 细胞依赖性的方式表现出协同的生存获益。该组合降低了 TIL 的耗竭并改善了 TIL 的功能。这种策略在针对颅内 CT2A 神经胶质瘤时最为成功。所有情况下的疗效均与 CD8 TIL 上的 4-1BB 表达水平相关,而与组织学或颅内与皮下肿瘤位置无关。为 T 细胞提供 4-1BB 表达,使得在 TIL 4-1BB 水平先前较低且治疗无效的模型中,组合 4-1BB 激动剂和 PD-1 阻断具有组合效应。
结论:尽管 T 细胞激活不良和严重的 T 细胞耗竭似乎是 GBM 中检查点阻断的限制因素,但 4-1BB 激动剂消除了这些限制,并与抗 PD-1 治疗联合使用时可产生长期生存。此外,这种联合治疗受到 TIL 4-1BB 表达的限制,而不受颅内环境的限制,因此可能特别适合 GBM。
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