Gephart Benjamin D, Coulter Don W, Solheim Joyce C
Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Int J Mol Sci. 2025 Jul 4;26(13):6440. doi: 10.3390/ijms26136440.
Cyclophosphamide (CPX) is an alkylating agent commonly used for various hematological and solid malignancies. In addition to its use as a cytotoxic agent to directly kill tumor cells, numerous immunomodulatory properties of CPX in the tumor microenvironment (TME) of several cancer types have also been documented. These properties include the selective depletion of immune-suppressive regulatory T cells (Tregs), triggering of immunogenic cell death (ICD) and enhanced antigen presentation, and release of type I interferons (IFNs). Moreover, preclinical models as well as human clinical trials have investigated the efficacy of the low-dose "metronomic" scheduling of CPX in combination with immunotherapies such as immune checkpoint inhibitors, dendritic cell tumor vaccines, and tumor antigen peptide vaccines. The metronomic dosing schedule involves administering a continuous (or frequent, such as daily) low dose of chemotherapy rather than using the canonical approach of administering the maximum tolerated dose. Despite the approval of immune checkpoint inhibitors for clinical usage against an increasing number of cancers, many malignancies simply do not respond to checkpoint inhibition, in part due to the heterogeneous intratumoral network of immune-suppressive cell populations. The immunomodulatory effects of cyclophosphamide have strong translational applicability and could serve to enhance and bolster anti-tumor immunity, potentially synergizing with immune checkpoint inhibitors and other existing immunotherapy agents.
环磷酰胺(CPX)是一种烷化剂,常用于治疗各种血液系统恶性肿瘤和实体瘤。除了作为细胞毒性药物直接杀死肿瘤细胞外,CPX在几种癌症类型的肿瘤微环境(TME)中的多种免疫调节特性也已得到证实。这些特性包括选择性清除免疫抑制性调节性T细胞(Tregs)、引发免疫原性细胞死亡(ICD)并增强抗原呈递,以及释放I型干扰素(IFN)。此外,临床前模型以及人体临床试验已经研究了低剂量“节拍式”给药方案的CPX与免疫疗法(如免疫检查点抑制剂、树突状细胞肿瘤疫苗和肿瘤抗原肽疫苗)联合使用的疗效。节拍式给药方案是指持续(或频繁,如每日)给予低剂量化疗,而不是采用给予最大耐受剂量的传统方法。尽管免疫检查点抑制剂已被批准用于临床治疗越来越多的癌症,但许多恶性肿瘤对检查点抑制根本没有反应,部分原因是肿瘤内免疫抑制细胞群体的异质性网络。环磷酰胺的免疫调节作用具有很强的转化适用性,可用于增强抗肿瘤免疫力,可能与免疫检查点抑制剂和其他现有的免疫治疗药物协同作用。