Abstract
Immune checkpoint inhibitors (ICI) have provided significant improvement in clinical outcomes for some patients with solid tumors. However, for patients with head and neck cancer, the response rate to ICI monotherapy remains low, leading to the exploration of combinatorial treatment strategies. In this preclinical study, we use an oncolytic adenovirus (Ad5/3) encoding hTNFα and hIL-2 and non-replicate adenoviruses (Ad5) encoding mTNFα and mIL-2 with ICI to achieve superior tumor growth control and improved survival outcomes. The in vitro effect of Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 was characterized through analyses of virus replication, transgene expression and lytic activity using head and neck cancer patient derived cell lines. Mouse models of ICI naïve and refractory oral cavity squamous cell carcinoma were established to evaluate the local and systemic anti-tumor immune response upon ICI treatment with or without the non-replicative adenovirus encoding mTNFα and mIL-2. We delineated the mechanism of action by measuring the metabolic activity and effector function of CD3+ tumor infiltrating lymphocytes (TIL) and transcriptomic profile of the CD45+ tumor immune compartment. Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 demonstrated robust replicative capability in vitro across all head and neck cell lines screened through potent lytic activity, E1a and transgene expression. In vivo, in both ICI naïve and refractory models, we observed improvement to tumor growth control and long-term survival when combining anti-PD-1 or anti-PD-L1 with the non-replicative adenovirus encoding mTNFα and mIL-2 compared to monotherapies. This observation was verified by striking CD3+ TIL derived mGranzyme b and interferon gamma production complemented by increased T cell bioenergetics. Notably, interrogation of the tumor immune transcriptome revealed the upregulation of a gene signature distinctive of tertiary lymphoid structure formation upon treatment of murine anti-PD-L1 refractory tumors with non-replicative adenovirus encoding mTNFα and mIL-2. In addition, we detected an increase in anti-tumor antibody production and expansion of the memory T cell compartment in the secondary lymphoid organs. In summary, a non-replicative adenovirus encoding mTNFα and mIL-2 potentiates ICI therapy, demonstrated by improved tumor growth control and survival in head and neck tumor-bearing mice. Moreover, the data reveals a potential approach for inducing tertiary lymphoid structure formation. Altogether our results support the clinical potential of combining this adenovirotherapy with anti-PD-1 or anti-PD-L1.
Highlights
Head and neck cancer is the sixth most common cancer worldwide and is anticipated to increase 30% by 2030 to 1.08 million new cases annually [1, 2]
We have previously reported that combining adenovirusmediated delivery of mTNFa and mIL-2 with anti-programmed death (PD)-1 or anti-programmed death ligand 1 (PD-L1) is beneficial, in models of immune checkpoint inhibitors (ICI) naïve and resistant murine B16.OVA melanoma [21, 22]
A summary showing the average cytotoxicity of Ad5/3-E2F-D24 and Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 in all 8 cell lines can be seen in Supplementary Figure 1D
Summary
Head and neck cancer is the sixth most common cancer worldwide and is anticipated to increase 30% by 2030 to 1.08 million new cases annually [1, 2]. The majority of cases (90%) are head and neck squamous cell carcinomas (HNSCC) located in the upper aerodigestive tract [3]. Existing treatment strategies for HNSCC rely on surgical resection, sometimes in combination with radiotherapy and/or chemotherapy, or radical chemoradiation. The majority of patients with advanced stage disease develop recurrence or distant metastases [4–6]. The 5-year overall survival remains modest (~60%), while patients with unresectable, advanced and metastatic disease, have a significantly poorer prognosis with an expected survival of less than 12 months [7, 8].
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