EXTH-16. DEVELOPMENT OF INTRATHECAL (IT) DRUG DELIVERY PLATFORM TO CURE BREAST CANCER (BC) LEPTOMENINGEAL DISEASE (LMD) BY PEPTIDE-PULSED TYPE 1 CONVENTIONAL DENDRITIC CELL (CDC1) VACCINE IN PRECLINICAL MODEL

Abstract

Abstract BACKGROUND LMD is a rare form of metastasis in the meninges. Approximately 5% of advanced stage BC will develop LMD and currently there is no cure. One of the major hurdles is drug penetration due to the blood brain barrier (BBB) and blood-cerebral spinal fluid (CSF)-barrier. While the Ommaya reservoir is used clinically to overcome this challenge, there has not been an optimized preclinical model that allows researchers to adequately test novel therapies in the CSF space. METHODS The Forsyth lab have recently developed an MRI-compatible device called the “murine Ommaya” which mimics the Ommaya reservoir and allows repeated IT administration of drugs in minute 3-7 μL directly into CSF, bypassing BBB. In a joint effort with Dr. Czerniecki, whose lab have developed a pipeline for screening immunogenic MHC class II peptides from tumor-associated oncodrivers and subsequently generating tumor-targeting cDC1s, we have created a platform to IT deliver peptide-pulsed cDC1 immunotherapy directly targeting BC-LMD. RESULTS Currently, we have tested the efficacy of treatment in HER2+ LMD and triple negative breast cancer (TNBC) LMD models and found a very favorable response; LMD mice that received IT cDC1 therapy showed tumor regression and their survival were significantly prolonged. About 70% of mice from HER2+ LMD and 30% from TNBC LMD were eventually disease-free. Cured mice also exhibited resistance against LMD recurrence. CONCLUSIONS Our preliminary data suggest IT cDC1 vaccine is effective against the incurable BC-LMD. We are currently investigating the mechanism(s) by which IT cDC1-initiated CD4 Th1 adaptive immune response against LMD. By using single-cell RNA-sequencing technique, we are analyzing the immune landscape in CSF tumor microenvironment in response to IT cDC1. FDA-approved phase 1 clinical trial has been funded by the DOD. Future approach includes employing our IT cDC1 immunotherapy platform in other cancer types, such as LMD from melanoma.