Combined immunotherapy encompassing intratumoral poly-ICLC, dendritic-cell vaccination and radiotherapy in advanced cancer patients.

Background: Combination immunotherapy has the potential to achieve additive or synergistic effects. Combined local injections of dsRNA analogues (mimicking viral RNA) and repeated vaccinations with tumor-lysate loaded dendritic cells shows efficacy against colon cancer mouse models. In the context of immunotherapy, radiotherapy can exert beneficial abscopal effects. Patients and methods: In this two-cohort pilot phase I study, 15 advanced cancer patients received two 4-week cycles of four intradermal daily doses of monocyte-derived dendritic cells preloaded with autologous tumor lysate and matured for 24 h with poly-ICLC (Hiltonol), TNF-α and IFN-α. On days +8 and +10 of each cycle, patients received intratumoral image-guided 0.25 mg injections of the dsRNA-analogue Hiltonol. Cyclophosphamide 600 mg/m2 was administered 1 week before. Six patients received stereotactic ablative radiotherapy (SABR) on selected tumor lesions, including those injected with Hiltonol. Expression of 25 immune-relevant genes was sequentially monitored by RT-PCR on circulating peripheral blood mononuclear cell (PBMCs) and serum concentrations of a cytokine panel were sequentially determined before and during treatment. Pre- and post-treatment PBMC from patients achieving durable stable disease (SD) were studied by IFNγ ELISPOT-assays responding to tumor-lysate loaded DC and by TCRß sequencing. Results: Combined treatment was, safe and well tolerated. One heavily pretreated castration-resistant prostate cancer patient experienced a remarkable mixed abscopal response to SABR+ immunotherapy. No objective responses were observed, while nine patients presented SD (five of them in the six-patient radiotherapy cohort). Intratumoral Hiltonol increased IFN-ß and IFN-α mRNA in circulating PBMC. DC vaccination increased serum IL-12 and IL-1ß concentrations, especially in patients presenting SD. IFNγ-ELISPOT reactivity to tumor lysates was observed in two patients experiencing durable SD. Conclusions: This radio-immunotherapy combination strategy, aimed at resembling viral infection in tumor tissue in combination with a dendritic-cell vaccine and SABR, is safe and shows immune-associated activity and signs of preliminary clinical efficacy.

A Semliki forest virus vector engineered to express IFNα induces efficient elimination of established tumors.

Semliki Forest virus (SFV) represents a promising gene therapy vector for tumor treatment, because it produces high levels of recombinant therapeutic proteins while inducing apoptosis in infected cells. In this study, we constructed a SFV vector expressing murine interferon alpha (IFNα). IFNα displays antitumor activity mainly by enhancing an antitumor immune response, as well as by a direct antiproliferative effect. In spite of the antiviral activity of IFNα, SFV-IFN could be produced in BHK cells at high titers. This vector was able to infect TC-1 cells, a tumor cell line expressing E6 and E7 proteins of human papillomavirus, leading to high production of IFNα both in vitro and in vivo. When injected into subcutaneous TC-1 tumors implanted in mice, SFV-IFN was able to induce an E7-specific cytotoxic T lymphocyte response, and to modify tumor infiltrating immune cells, reducing the percentage of T regulatory cells and activating myeloid cells. As a consequence, SFV-IFN was able to eradicate 58% of established tumors treated 21 days after implantation with long-term tumor-free survival and very low toxicity. SFV-IFN was also able to induce significant antitumor responses in a subcutaneous tumor model of murine colon adenocarcimoma. These data suggest that local production of IFNα by intratumoral injection of recombinant SFV-IFN could represent a potent new strategy to treat tumors in patients.

Commentary on Pharmacometrics for Immunotherapy.

This commentary provides an overview of recent examples of pharmacometrics applied during the clinical development of two antagonists of the programmed death-1 (PD-1) cell surface receptor, pembrolizumab and nivolumab. Despite the remarkable achievements obtained in predicting the correct dosing schedule from different quantitative approaches, data indicated a great degree of heterogeneity in tumor response. To achieve therapeutic goals the search for predictive biomarkers associated with a lack of response and mechanism-based combination studies are warranted.

Antitumoral efficacy of DNA nanoparticles in murine models of lung cancer and pulmonary metastasis.

Polyethylenimine (PEI)-DNA complexes are nanoparticles that are able to efficiently transfer plasmids to the lungs. Interleukin-12 (IL12) gene transfer using PEI may represent an important strategy for lung cancer treatment. In this study, we evaluated the antitumoral efficacy of the administration of PEI-DNA nanoparticles carrying IL12 gene (PEI-IL12) for the treatment of lung cancer and pulmonary metastases in animal models. After inoculation of tumor cells, mice were treated intravenously with a single dose of PEI-IL12, PEI nanoparticles carrying the reporter gene beta-galactosidase (PEI-LacZ) or vehicle. Transgene expression, survival rates and immune response were analyzed in both models. Administration of PEI-LacZ and PEI-IL12 nanoparticles controlled tumor growth and prolonged survival times in both animal models. Although PEI-IL12 and PEI-LacZ administration showed similar antitumoral effects in the lung cancer model, the efficacy of PEI-IL12 was significantly superior in the inhibition of the development of pulmonary metastases. Furthermore, the administration of PEI-DNA nanoparticles results in the production of high levels of proinflammatory cytokines. Our results showed that PEI-DNA nanoparticles are an efficient vector for mediating gene transfer to the lungs, are a potent inducer of the innate immune response and represents an interesting strategy for the treatment of bronchogenic carcinoma and metastatic lung carcinoma.

Protection against woodchuck hepatitis virus (WHV) infection by gene gun coimmunization with WHV core and interleukin-12.

Woodchuck hepatitis virus (WHV) and hepatitis B virus (HBV) are closely similar with respect to genomic organization, host antiviral responses, and pathobiology of the infection. T-cell immunity against viral nucleocapsid (HBcAg or WHcAg) has been shown to play a critical role in viral clearance and protection against infection. Here we show that vaccination of healthy woodchucks by gene gun bombardment with a plasmid coding for WHcAg (pCw) stimulates proliferation of WHcAg-specific T cells but that these cells do not produce significant levels of gamma interferon (IFN-gamma) upon antigen stimulation. In addition, animals vaccinated with pCw alone were not protected against WHV inoculation. In order to induce a Th1 cytokine response, another group of woodchucks was immunized with pCw together with another plasmid coding for woodchuck interleukin-12 (IL-12). These animals exhibited WHcAg-specific T-cell proliferation with high IFN-gamma production and were protected against challenge with WHV, showing no viremia or low-level transient viremia after WHV inoculation. In conclusion, gene gun immunization with WHV core generates a non-Th1 type of response which does not protect against experimental infection. However, steering the immune response to a Th1 cytokine profile by IL-12 coadministration achieves protective immunity. These data demonstrate a crucial role of Th1 responses in the control of hepadnavirus replication and suggest new approaches to inducing protection against HBV infection.

Absence of surface expression of CD137 (4-1BB) on Myeloid-derived suppressor cells

Las células mieloides supresoras (Myeloid-derived suppressorcells, MDSC) pertenecen a un subtipo de leucocitos causantes deinmunosupresión en individuos portadores de tumor. En ratones,estas células han sido definidas como CD11b+GR1+IL-4Rá+y, debido a la presencia de tumores en modelos experimentales,se acumulan tanto en la lesión tumoral como en los órganos linfoides.CD137 (4-1BB) es un receptor de coestímulo de la familia dereceptores del factor de necrosis tumoral (TNF) principalmenteexpresado sobre la membrana de linfocitos T y de células NK(Natural Killer) activados, aunque también se encuentra en la superficiede otros leucocitos de estirpe mieloide como mastocitos, granulocitos,macrófagos, células dendríticas y endotelio. Anticuerposagonistas frente a CD137 incrementan la respuesta inmuneantitumoral potenciando los CTLs antitumorales. En este trabajo,células de carcinoma de colon C26 transfectadas para expresarGM-CSF se inocularon por vía subcutánea a ratones singénicosdebido a sus propiedades inductoras de un gran aumento enel número de las MDSCs. Mediante citometría de flujo multicolorhemos confirmado un notable aumento en el número de estascélulas CD11b+GR1+IL-4Rá+ tanto en el estroma tumoral comoen el bazo de los ratones portadores de tumor. La expresión deCD137 en este subtipo celular sin embargo, mostró resultadosnegativos. Por tanto, se pueden excluir los efectos directos de losmAbs sobre MDSCs como mecanismo de acción de la inmunoterapiacon anticuerpos anti-CD137. Según esto las terapias dirigidasa disminuir el número o función de MDSCs podrían sinergizarcon anticuerpos inmunoterapéuticos anti-CD137 ya queactúan sobre dianas diferentes

Myeloid-derived suppressor cells (MDSC) are a subset ofleukocytes associated with local and systemic T-cell immunosuppressionin tumor-bearing hosts. In mice these cells are bestdefined as CD11b+GR1+IL-4Rá+ and their numbers increase inresponse to the presence of an experimental malignancy both atthe tumor lesion and in lymphoid organs. CD137 is a co-stimulatoryreceptor that belongs to the tumor necrosis factor (TNF)receptor family characteristically expressed on activated T cellsand NK cells. Its expression has also been reported on myeloidcells such as mastocytes, granulocytes, macrophages, dendriticcells, and on endothelium. Agonist antibodies against CD137 areknown to increase the antitumor immune response through augmentingthe intensity of antitumor CTLs. In this study C26 coloncarcinoma cells transfected to express GM-CSF were subcutaneouslyimplanted in syngeneic mice because of its properties asthe most potent inducer of MDSCs. Indeed, multicolor flow cytometryconfirmed a dramatic numeric increase in CD11b+GR1+IL-4Rá+ cells both in the tumor stroma and in the spleen of tumorbearingmice. Analysis of CD137 expression on this cell subsetrendered completely negative results. Therefore direct effects ofimmunotherapeutic anti-CD137 monoclonal antibodies on MDSCscan be excluded as a mechanism of action, thus indicating thattherapies aimed at decreasing MDSCs might synergize withimmunotherapeutic anti-CD137 antibody as a result of dealing with different targets