Comen Elizabeth, Budhu Sadna, Elhanati Yuval, Page David, Rasalan-Ho Teresa, Ritter Erika, Wong Phillip, Plitas George, Patil Sujata, Brogi Edi, Jochelson Maxine, Bryce Yolanda, Solomon Stephen B, Norton Larry, Merghoub Taha, McArthur Heather L
Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ludwig Collaborative and Swim Across America Laboratory, Department of Pharmacology and Mayer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
iScience. 2024 Jan 12;27(2):108880. doi: 10.1016/j.isci.2024.108880. eCollection 2024 Feb 16.
Local cryoablation can engender systemic immune activation/anticancer responses in tumors otherwise resistant to immune checkpoint blockade (ICB). We evaluated the safety/tolerability of preoperative cryoablation plus ipilimumab and nivolumab in 5 early-stage/resectable breast cancers. The primary endpoint was met when all 5 patients underwent standard-of-care primary breast surgery undelayedly. Three patients developed transient hyperthyroidism; one developed grade 4 liver toxicity (resolved with supportive management). We compared this strategy with cryoablation and/or ipilimumab. Dual ICB plus cryoablation induced higher expression of T cell activation markers and serum Th1 cytokines and reduced immunosuppressive serum CD4PD-1 T cells, improving effector-to-suppressor T cell ratio. After dual ICB and before cryoablation, T cell receptor sequencing of 4 patients showed increased T cell clonality. In this small subset of patients, we provide preliminary evidence that preoperative cryoablation plus ipilimumab and nivolumab is feasible, inducing systemic adaptive immune activation potentially more robust than cryoablation with/without ipilimumab.
局部冷冻消融可在原本对免疫检查点阻断(ICB)耐药的肿瘤中引发全身免疫激活/抗癌反应。我们评估了术前冷冻消融联合伊匹木单抗和纳武单抗在5例早期/可切除乳腺癌患者中的安全性/耐受性。当所有5例患者均顺利接受标准治疗的原发性乳腺癌手术时,达到了主要终点。3例患者出现短暂性甲状腺功能亢进;1例出现4级肝毒性(经支持治疗后缓解)。我们将该策略与冷冻消融和/或伊匹木单抗进行了比较。双重ICB联合冷冻消融诱导了更高的T细胞激活标志物表达和血清Th1细胞因子水平,并减少了免疫抑制性血清CD4PD-1 T细胞,改善了效应性T细胞与抑制性T细胞的比例。在双重ICB后且在冷冻消融前,4例患者的T细胞受体测序显示T细胞克隆性增加。在这个小样本患者群体中,我们提供了初步证据,表明术前冷冻消融联合伊匹木单抗和纳武单抗是可行的,可诱导全身适应性免疫激活,可能比单独使用或不使用伊匹木单抗的冷冻消融更有效。
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