Hack Stephen P, Zhu Andrew X, Wang Yulei
Product Development (Oncology), Genentech, Inc., South San Francisco, CA, United States.
Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, United States.
Front Immunol. 2020 Nov 5;11:598877. doi: 10.3389/fimmu.2020.598877. eCollection 2020.
Cancer immunotherapy (CIT) with antibodies targeting the programmed cell death 1 protein (PD-1)/programmed cell death 1 ligand 1 (PD-L1) axis have changed the standard of care in multiple cancers. However, durable antitumor responses have been observed in only a minority of patients, indicating the presence of other inhibitory mechanisms that act to restrain anticancer immunity. Therefore, new therapeutic strategies targeted against other immune suppressive mechanisms are needed to enhance anticancer immunity and maximize the clinical benefit of CIT in patients who are resistant to immune checkpoint inhibition. Preclinical and clinical studies have identified abnormalities in the tumor microenvironment (TME) that can negatively impact the efficacy of PD-1/PD-L1 blockade. Angiogenic factors such as vascular endothelial growth factor (VEGF) drive immunosuppression in the TME by inducing vascular abnormalities, suppressing antigen presentation and immune effector cells, or augmenting the immune suppressive activity of regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages. In turn, immunosuppressive cells can drive angiogenesis, thereby creating a vicious cycle of suppressed antitumor immunity. VEGF-mediated immune suppression in the TME and its negative impact on the efficacy of CIT provide a therapeutic rationale to combine PD-1/PD-L1 antibodies with anti-VEGF drugs in order to normalize the TME. A multitude of clinical trials have been initiated to evaluate combinations of a PD-1/PD-L1 antibody with an anti-VEGF in a variety of cancers. Recently, the positive results from five Phase III studies in non-small cell lung cancer (adenocarcinoma), renal cell carcinoma, and hepatocellular carcinoma have shown that combinations of PD-1/PD-L1 antibodies and anti-VEGF agents significantly improved clinical outcomes compared with respective standards of care. Such combinations have been approved by health authorities and are now standard treatment options for renal cell carcinoma, non-small cell lung cancer, and hepatocellular carcinoma. A plethora of other randomized studies of similar combinations are currently ongoing. Here, we discuss the principle mechanisms of VEGF-mediated immunosuppression studied in preclinical models or as part of translational clinical studies. We also discuss data from recently reported randomized clinical trials. Finally, we discuss how these concepts and approaches can be further incorporated into clinical practice to improve immunotherapy outcomes for patients with cancer.
靶向程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡蛋白1配体1(PD-L1)轴的抗体癌症免疫疗法(CIT)已经改变了多种癌症的治疗标准。然而,仅在少数患者中观察到持久的抗肿瘤反应,这表明存在其他抑制机制来抑制抗癌免疫。因此,需要针对其他免疫抑制机制的新治疗策略,以增强抗癌免疫力,并使对免疫检查点抑制耐药的患者从CIT中获得最大的临床益处。临床前和临床研究已经确定肿瘤微环境(TME)中的异常情况会对PD-1/PD-L1阻断的疗效产生负面影响。血管内皮生长因子(VEGF)等血管生成因子通过诱导血管异常、抑制抗原呈递和免疫效应细胞,或增强调节性T细胞、骨髓来源的抑制细胞和肿瘤相关巨噬细胞的免疫抑制活性,在TME中驱动免疫抑制。反过来,免疫抑制细胞可以驱动血管生成,从而形成抗肿瘤免疫抑制的恶性循环。TME中VEGF介导的免疫抑制及其对CIT疗效的负面影响为将PD-1/PD-L1抗体与抗VEGF药物联合使用以使TME正常化提供了治疗依据。已经启动了许多临床试验来评估PD-1/PD-L1抗体与抗VEGF在多种癌症中的联合应用。最近,在非小细胞肺癌(腺癌)、肾细胞癌和肝细胞癌的五项III期研究中取得的阳性结果表明,与各自的标准治疗相比,PD-1/PD-L1抗体和抗VEGF药物的联合应用显著改善了临床结局。这种联合疗法已获得卫生当局的批准,现在是肾细胞癌、非小细胞肺癌和肝细胞癌的标准治疗选择。目前正在进行大量关于类似联合疗法的其他随机研究。在此,我们讨论在临床前模型中或作为转化临床研究的一部分所研究的VEGF介导的免疫抑制的主要机制。我们还将讨论最近报道的随机临床试验的数据。最后,我们将讨论如何将这些概念和方法进一步纳入临床实践,以改善癌症患者的免疫治疗效果。
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