Department of Surgery, Division of Surgical Sciences, Duke University, Durham North Carolina.
Department of Oncology, Wayne State University, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
Clin Cancer Res. 2020 Sep 1;26(17):4670-4681. doi: 10.1158/1078-0432.CCR-20-0389. Epub 2020 Jul 30.
PURPOSE: Despite promising advances in breast cancer immunotherapy, augmenting T-cell infiltration has remained a significant challenge. Although neither individual vaccines nor immune checkpoint blockade (ICB) have had broad success as monotherapies, we hypothesized that targeted vaccination against an oncogenic driver in combination with ICB could direct and enable antitumor immunity in advanced cancers. EXPERIMENTAL DESIGN: Our models of HER2 breast cancer exhibit molecular signatures that are reflective of advanced human HER2 breast cancer, with a small numbers of neoepitopes and elevated immunosuppressive markers. Using these, we vaccinated against the oncogenic HER2Δ16 isoform, a nondriver tumor-associated gene (GFP), and specific neoepitopes. We further tested the effect of vaccination or anti-PD-1, alone and in combination. RESULTS: We found that only vaccination targeting HER2Δ16, a driver of oncogenicity and HER2-therapeutic resistance, could elicit significant antitumor responses, while vaccines targeting a nondriver tumor-specific antigen or tumor neoepitopes did not. Vaccine-induced HER2-specific CD8 T cells were essential for responses, which were more effective early in tumor development. Long-term tumor control of advanced cancers occurred only when HER2Δ16 vaccination was combined with αPD-1. Single-cell RNA sequencing of tumor-infiltrating T cells revealed that while vaccination expanded CD8 T cells, only the combination of vaccine with αPD-1 induced functional gene expression signatures in those CD8 T cells. Furthermore, we show that expanded clones are HER2-reactive, conclusively demonstrating the efficacy of this vaccination strategy in targeting HER2. CONCLUSIONS: Combining oncogenic driver targeted vaccines with selective ICB offers a rational paradigm for precision immunotherapy, which we are clinically evaluating in a phase II trial (NCT03632941).
目的:尽管乳腺癌免疫疗法取得了令人鼓舞的进展,但增加 T 细胞浸润仍然是一个重大挑战。虽然单独的疫苗或免疫检查点阻断(ICB)作为单一疗法都没有取得广泛的成功,但我们假设针对致癌驱动因素的靶向疫苗接种与 ICB 联合使用,可以在晚期癌症中指导和实现抗肿瘤免疫。
实验设计:我们的 HER2 乳腺癌模型表现出与晚期人类 HER2 乳腺癌具有分子相似性的特征,具有少量的新抗原和升高的免疫抑制标志物。使用这些模型,我们针对致癌的 HER2Δ16 异构体、非驱动性肿瘤相关基因(GFP)和特定的新抗原进行了疫苗接种。我们进一步测试了疫苗接种或抗 PD-1 的单独和联合使用的效果。
结果:我们发现,只有针对致癌驱动因素和 HER2 治疗耐药性的 HER2Δ16 的疫苗接种才能引起显著的抗肿瘤反应,而针对非驱动性肿瘤特异性抗原或肿瘤新抗原的疫苗接种则不能。疫苗诱导的 HER2 特异性 CD8 T 细胞对于反应至关重要,而在肿瘤发展早期反应更为有效。只有当 HER2Δ16 疫苗接种与 αPD-1 联合使用时,才能对晚期癌症进行长期肿瘤控制。对肿瘤浸润 T 细胞的单细胞 RNA 测序表明,虽然疫苗接种可扩增 CD8 T 细胞,但只有疫苗与 αPD-1 的联合使用才能在这些 CD8 T 细胞中诱导功能性基因表达特征。此外,我们还表明扩增的克隆是 HER2 反应性的,这明确证明了这种疫苗接种策略在靶向 HER2 方面的疗效。
结论:将针对致癌驱动因素的靶向疫苗接种与选择性 ICB 联合使用为精准免疫疗法提供了一个合理的范例,我们正在一项 II 期临床试验(NCT03632941)中对其进行临床评估。
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