Antitumor Efficacy Of Combination Research Articles

Abstract 77: MSC loaded oncolytic virus and expressing immunomodulators have therapeutic efficacy in advanced melanomas

Abstract Patients with advanced melanoma have a high propensity to metastasize to the brain and numerous investigational treatments with targeted agents have shown modest response in melanoma brain metastatic patients. Therefore, there is an urgent need to develop innovative therapies for such tumors. Oncolytic herpes simplex virus (oHSV) that selectively replicate in tumor cells and illicit an antitumor effect via oncolysis and production of neoantigens is among the recently approved promising therapies for primary melanoma patients. However, virus neutralization, and inefficient extravasation are the major barriers to the effective systemic delivery of oHSV to target metastatic tumor lesions in the brain. We have previously shown that mesenchymal stem cells (MSC) armed with different oHSV variants (MSC-oHSV) home to metastatic tumor lesions and have therapeutic benefits in melanoma brain metastases (MBM) models. To enhance therapeutic efficacy for metastasis melanoma, we investigated the novel combined therapy using MSC loaded with oHSV and simultaneously MSC releasing GM-CSF. Based on our TCGA data indicating significant loss of PTEN expression in late-stage metastatic melanoma, we tested MSC based therapeutics in PTEN mutant mouse melanomas. We show that MSC loaded oHSV effectively kills PTEN mutant syngeneic tumor cells in vitro. Next, we established MSC secreting GM-CSF and tested the abscopal effects as well as the antitumor efficacy in combination with MSC-oHSV in PTEN mutant syngeneic bilateral subcutaneous tumor model. The combined MSC based therapy showed significant therapeutic effects at both the treated and untreated site compared to control therapies. Interestingly, when these mice after combination therapy were re-challenged with mouse melanoma cells injected into brain, all mice remained tumor free. The combined MSC therapy induced effector memory CD8 and central memory CD8 cells in spleen and there was no toxicity in major organs post-therapy. In conclusion, our data indicate that combined MSC-oHSV/GM-CSF therapy is a promising novel therapy for advanced melanomas. Citation Format: Nobuhiko Kanaya, Maria Lopez Vazquez, Arnaldo J. Franco Torres, Yohei Kitamura, Genevieve M. Boland, Khalid Shah. MSC loaded oncolytic virus and expressing immunomodulators have therapeutic efficacy in advanced melanomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 77.

Obatoclax, the pan-Bcl-2 inhibitor sensitizes hepatocellular carcinoma cells to promote the anti-tumor efficacy in combination with immune checkpoint blockade

Bcl-2 family proteins play critical roles in regulating lymphocyte development and maintain homeostasis, and have also been proved to be involved in various cancer types development. However, the role of Bcl-2 in hepatocellular carcinoma (HCC) development has not been clearly studied. Here, we reported the pan-Bcl-2 inhibitor, obatoclax could directly inhibit HCC growth in vitro. We further demonstrated in murine HCC model that obatoclax also suppressed HCC development in vivo. We also proved that although obatoclax inhibited T cells expansion, it had no influence on T cells activation in vivo. Mechanism study revealed that obatoclax sensitized HCC cells to T cell-mediated killing. Combination therapy of obatoclax with anti-PD-1 antibody synergistically suppressed HCC development and prolonged the survival rate of tumor-bearing mice. The combination therapy promoted T cells activation and effector cytokines expression both in spleen and tumor. In summary, our results proved that obatoclax sensitized HCC cells to T cell -mediated killing. Combination of obatoclax with immune checkpoint blockade served as a promising therapeutic strategy for HCC treatment.

Abstract PO-088: Bintrafusp alfa enhances anti-tumor efficacy in combination with radiation therapy plus the ataxia telangiectasia mutated (ATM) inhibitor, M4076

Abstract Ionizing radiation therapy (RT) is a standard of care for many cancer indications. RT promotes the activation of transforming growth factor (TGF)-β, a pleotropic cytokine that mediates RT-induced fibrosis and suppresses anti-tumor immunity. Additionally, RT induces the expression of the immunosuppressive checkpoint PD-L1 on tumor cells. Bintrafusp alfa (M7824) is a first-in-class bifunctional fusion protein composed of the extracellular domain of the TGF-βRII receptor, functioning as a TGF-β “trap”, fused to a human IgG1 antibody blocking PD-L1. Bintrafusp alfa enhances anti-tumor immunity elicited by RT and reverses RT-induced fibrosis in preclinical models. Inhibition of ataxia telangiectasia mutated (ATM) increases the cancer cell's sensitivity to radiotherapy by blocking cellular pathways which facilitate the response to, and repair of, RT induced DNA double strand breaks. We hypothesize that a combination therapy consisting of bintrafusp alfa, RT and the ATM kinase inhibitor M4076 will show greater anti-tumor efficacy than the respective mono- or dual-combination therapies in immune competent preclinical solid tumor models. The anti-tumor efficacy of bintrafusp alfa, RT, and M4076 triple combination therapy was explored in the immune therapy resistant 4T1 murine syngeneic breast carcinoma model. This triple combination therapy significantly increased anti-tumor efficacy and prolonged overall survival relative to the bintrafusp alfa + RT or M4076 + RT dual combination therapies. The triple combination was further evaluated in the more immunogenic MC38 colon carcinoma model. MC38 tumor bearing mice treated with the triple combination therapy showed a significantly greater tumor growth inhibition and long term tumor free survival when compared with the bintrafusp alfa + RT or M4076 + RT treatment groups. Finally, the bintrafusp alfa + RT + M4076 combination therapy also showed significantly greater tumor growth inhibition and long term tumor free survival when compared to the combination of anti-PD-L1 + RT + M4076. The bintrafusp alfa triple combination resulted in 8 of 10 mice showing long term tumor free survival, whereas the anti-PD-L1 triple combination failed to elicit tumor free survival (0 of 10 mice tumor free). These studies demonstrate the superior anti-tumor efficacy of the Bintrafusp alfa + RT + M4076 triple combination therapy over that of the dual combination therapies of RT + bintrafusp alfa or RT + M4076. These data in the MC38 model also suggest that bintrafusp alfa may promote a superior anti-tumor immune response relative to that of anti-PD-L1 when in combination with RT and M4076. Together, these data support the rational to develop a bintrafusp alfa + RT + M4076 combination therapy for the treatment of solid tumors. Citation Format: Adam Lazorchak, Huakui Yu, Guozhong Qin, Jin Qi, Bo Marelli, Yan Lan. Bintrafusp alfa enhances anti-tumor efficacy in combination with radiation therapy plus the ataxia telangiectasia mutated (ATM) inhibitor, M4076 [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-088.

Immuno-Oncolytic Viruses: Emerging Options in the Treatment of Colorectal Cancer.

Colorectal cancer is the third most common neoplasm in the world and the third leading cause of cancer-related deaths in the USA. A safer and more effective therapeutic intervention against this malignant carcinoma is called for given the limitations and toxicities associated with the currently available treatment modalities. Immuno-oncolytic or oncolytic virotherapy, the use of viruses to selectively or preferentially kill cancer cells, has emerged as a potential anticancer treatment modality. Oncolytic viruses act as double-edged swords against the tumors through the direct cytolysis of cancer cells and the induction of antitumor immunity. A number of such viruses have been tested against colorectal cancer, in both preclinical and clinical settings, and many have produced promising results. Oncolytic virotherapy has also shown synergistic antitumor efficacy in combination with conventional treatment regimens. In this review, we describe the status of this therapeutic approach against colorectal cancer at both preclinical and clinical levels. Successes with and the challenges of using oncolytic viruses, both as monotherapy and in combination therapy, are also highlighted.

CD36-mediated ferroptosis dampens intratumoral CD8+ T cell effector function and impairs their antitumor ability

Understanding the mechanisms underlying how T cells become dysfunctional in a tumor microenvironment (TME) will greatly benefit cancer immunotherapy. We found that increased CD36 expression in tumor-infiltrating CD8+ T cells, which was induced by TME cholesterol, was associated with tumor progression and poor survival in human and murine cancers. Genetic ablation of Cd36 in effector CD8+ T cells exhibited increased cytotoxic cytokine production and enhanced tumor eradication. CD36 mediated uptake of fatty acids by tumor-infiltrating CD8+ T cells in TME, induced lipid peroxidation and ferroptosis, and led to reduced cytotoxic cytokine production and impaired antitumor ability. Blocking CD36 or inhibiting ferroptosis in CD8+ T cells effectively restored their antitumor activity and, more importantly, possessed greater antitumor efficacy in combination with anti-PD-1 antibodies. This study reveals a new mechanism of CD36 regulating the function of CD8+ effector T cells and therapeutic potential of targeting CD36 or inhibiting ferroptosis to restore T cell function.

Abstract PS10-04: Tucatinib favourably modulates the immune microenvironment and synergises with anti-PD1 therapy in a trastuzumab resistant HER2+ murine model

Abstract Background: The efficacy of PD-(L)1 inhibitors in patients with trastuzumab-resistant advanced HER2+ breast cancer is poor. Although many HER2 targeted therapies are used clinically, their effect on the tumor immune microenvironment (TME) and whether this contributes to efficacy is not understood. Tucatinib is a potent, highly selective, HER2 small molecule tyrosine kinase inhibitor with proven clinical benefit in the advanced setting. Methods: We used two immunocompetent, HER2+ murine cancer models (trastuzumab-sensitive H2N113 and trastuzumab-resistant fo5) to investigate the effects of tucatinib on tumor growth kinetics, as well as tucatinib anti-tumor efficacy in combination with trastuzumab and PD-1 checkpoint blockade. Effects of tucatinib on the tumor infiltrating lymphocytes were analysed using flow cytometry. To identify genes that were modulated by tucatinib treatment, we performed bulk RNA sequencing on fo5 tumors treated with vehicle or tucatinib. We evaluated healthy donor peripheral blood T cells treated with tucatinib for 96 hours and analysed secreted cytokine levels using cytometric bead array. Results: Treatment of CD4+ and CD8+ T cells with tucatinib together with TCR stimulation resulted significantly higher levels of IFNγ and TNFα compared with stimulated controls (p < 0.0001), suggesting tucatinib can directly modulate human T cell function. In both murine models, tucatinib significantly inhibited tumor growth in a dose-dependent manner and was observed at doses of 25 mg/kg, 50 mg/kg and 100 mg/kg (p < 0.05 between each dose). Median survival was 16 days in the vehicle group vs 50 days with 100 mg/kg of tucatinib (p < 0.0001). Ex vivo analysis of tumors by flow cytometry showed increased infiltration of NK cells (p=0.01) and, CD8+ T cells with high PD-1 (p = 0.001), TIM-3 (p = 0.009), IFNγ (p = 0.003) and Ki67 (p = 0.0003) expression in Tucatinib treated mice compared to vehicle treated mice. Concomitant with these changes there was a significant reduction in numbers of neutrophils (p = 0.0085) and MHC-II low expressing macrophage populations (p < 0.0001) following tucatininb treatment with an increase in frequency of MHC-II expressing dendritic cells (p < 0.0001) and macrophages (p < 0.0001) suggesting an increase in anti-tumor immunity. Similarly, in the fo5 model tucatinib treated tumors had significantly higher interferon-γ (IFNγ) produced by CD8+ T cells (p = 0.005). Gene expression profile analysis shows significant enrichment in pathways associated with immune activation, including antigen binding and presentation (p = 0.0002), adaptive immune responses (p = 0.0002) including IFNγ (p = 0.0002) and IFNα (p = 0.0002). In this model, tucatinib in combination with trastuzumab demonstrated significantly better anti-tumor activity (p = 0.03) and survival (p < 0.0001) compared with tucatinib alone, with 33% of mice achieving complete tumour regressions. Tucatinib in combination with PD-1 inhibition also demonstrated significantly greater anti-tumor efficacy compared to tucatinib alone (p = 0.0079) with increased survival (p = 0.05) and 50% of mice achieving complete tumor regression. Conclusions: This study suggests an anti-tumor immune response may be an important component of the efficacy of tucatinib. This is supported by in vitro data demonstrating tucatinib stimulated human peripheral T cells and in vivo data showing favorable effects on the TME mediated by tucatinib treatment. These changes were associated with improved efficacy when tucatinib was combined with PD-1 inhibition or trastuzumab in the setting of trastuzumab resistance. These findings suggest that the combination of tucatinib and PD-1 inhibition is a rational combination that warrants investigation in the clinical setting, particularly for trastuzumab resistant HER2+ breast tumors. Citation Format: Ran Li, Sneha Sant, Emmaline Brown, Franco Caramia, Ann Byrne, Kylie Clarke, Michael Neeson, Paul J Neeson, Phillip K Darcy, Scott Peterson, Sherene Loi. Tucatinib favourably modulates the immune microenvironment and synergises with anti-PD1 therapy in a trastuzumab resistant HER2+ murine model [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-04.

Enhanced antitumor immunity by a novel small molecule HPK1 inhibitor

BackgroundHematopoietic progenitor kinase 1 (HPK1 or MAP4K1) has been demonstrated as a negative intracellular immune checkpoint in mediating antitumor immunity in studies with HPK1 knockout and kinase dead mice. Pharmacological...

Metronomic delivery of orally available pemetrexed-incorporated colloidal dispersions for boosting tumor-specific immunity

In this study, we developed oral pemetrexed (PMX) for metronomic dosing to enhance antitumor immunity. PMX was electrostatically complexed with positively charged lysine-linked deoxycholic acid (DL) as an intestinal permeation enhancer, forming PMX/DL, to enhance its intestinal permeability. PMX/DL was also incorporated into a colloidal dispersion (CD) comprised of the block copolymer of poly(ethylene oxide) and poly(propylene oxide), and caprylocaproyl macrogol-8 glycerides (PMX/DL-CD). CD-containing PMX/DL complex in a 1:1 molar ratio [PMX/DL(1:1)-CD] showed 4.66- and 7.19-fold greater permeability than free PMX through the Caco-2 cell monolayer and rat intestine, respectively. This resulted in a 282% improvement in oral bioavailability in rats. In addition, low-dose metronomic PMX led to more immunogenic cell death in CT26.CL25 cells compared to high PMX concentrations at the maximum tolerated dose. In CT26.CL25 tumor-bearing mice, oral metronomic PMX/DL-CD elicited greater antitumor immunity not only by enhancing the number of tumor-infiltrating lymphocytes but also by suppressing T cell functions. Oral PMX/DL-CD substantially increased programmed cell death protein ligand-1 (PD-L1) expression on tumor cells compared to the control and PMX-IV groups. This increased antitumor efficacy in combination with anti-programmed cell death protein-1 (aPD-1) antibody in terms of tumor rejection and immunological memory compared to the combination of PMX-IV and aPD-1. These results suggest that oral metronomic scheduling of PMX/DL-CD in combination with immunotherapy has synergistic antitumor effects.

Venetoclax Increases Intratumoral Effector T Cells and Antitumor Efficacy in Combination with Immune Checkpoint Blockade.

The antiapoptotic protein BCL2 plays critical roles in regulating lymphocyte development and immune responses, and has also been implicated in tumorigenesis and tumor survival. However, it is unknown whether BCL2 is critical for antitumor immune responses. We evaluated whether venetoclax, a selective small-molecule inhibitor of BCL2, would influence the antitumor activity of immune checkpoint inhibitors (ICI). We demonstrate in mouse syngeneic tumor models that venetoclax can augment the antitumor efficacy of ICIs accompanied by the increase of PD-1+ T effector memory cells. Venetoclax did not impair human T-cell function in response to antigen stimuli in vitro and did not antagonize T-cell activation induced by anti-PD-1. Furthermore, we demonstrate that the antiapoptotic family member BCL-XL provides a survival advantage in effector T cells following inhibition of BCL2. Taken together, these data provide evidence that venetoclax should be further explored in combination with ICIs for cancer therapy. SIGNIFICANCE: The antiapoptotic oncoprotein BCL2 plays critical roles in tumorigenesis, tumor survival, lymphocyte development, and immune system regulation. Here we demonstrate that venetoclax, the first FDA/European Medicines Agency-approved BCL2 inhibitor, unexpectedly can be combined preclinically with immune checkpoint inhibitors to enhance anticancer immunotherapy, warranting clinical evaluation of these combinations.This article is highlighted in the In This Issue feature, p. 1.

CD47/SIRPα blocking peptide identification and synergistic effect with irradiation for cancer immunotherapy

BackgroundImmunotherapy has achieved remarkable advances via a variety of strategies against tumor cells that evade immune surveillance. As important innate immune cells, macrophages play important roles in maintaining homeostasis, preventing...

Abstract 6272: Redirecting tumor extracellular proteases to target radiosensitizer delivery

Abstract Patients with locally advanced cancers are treated with combined radiotherapy and chemotherapy, however curability is poor and side effects severe. Drugs that sensitize tumors to radiotherapy have been tried to improve cure, but tumor specificity remains a challenge. To achieve tumor selectivity of small molecule radiosensitizers, we tested as a strategy active tumor targeting utilizing peptide-based drug conjugates that split the responsibilities for targeting and radiosensitization into distinct molecular tasks. The tumor milieu possesses localizing beacons that can guide drug delivery using tumor cell surface receptors and microenvironment extracellular matrix metalloproteinases (MMPs). Here we applied peptide-based linkers to test for tumor selective drug delivery and radiosensitization by chemically conjugating the DNA damage checkpoint kinase 1/2 inhibitor AZD7762 to antibody to or cell penetrating peptides. AZD7762 governs DNA damage response and irradiated cell fate. We synthesized drug conjugates of AZD7762 and compared their anti-tumor efficacy in combination with ionizing radiation (IR). An antibody drug conjugate (ADC) was built by attaching AZD7762 to the anti-EGFR antibody cetuximab. Polycationic cell penetrating peptide drug conjugates were constructed by linking AZD7762 to a 9 amino acid repeat of D-arginine and keeping it bare (r9-AZD7762) or cloaking r9 within a MMP-2/9 triggered activatable cell penetrating peptide scaffold (ACPP-AZD7762). In contrast to receptor directed ADCs, ACPPs redirect extracellular tumor microenvironment proteases to guide drug delivery. Intact, ACPPs are charge neutral which blocks the conjugated drug from cell entry. Upon cleavage by tumor overexpressed MMPs, the ACPP scaffold releases drug conjugated polycationic peptide which is then internalized by cells. We found that while cetuximab-AZD7762 ADC had high affinity for EGFR overexpressing tumor cells and prolonged blood circulation in murine models, cetuximab-AZD7762 lacked anti-tumor efficacy. On the other extreme, naked r9-AZD7762 drug conjugate was indiscriminately cytotoxic and radiosensitized a panel of tumor cell lines in cell culture: CAL27, A549, PANC1 and HCT116. However, r9 cell penetrating peptides lacked tumor specificity when intravenously injected into mice. In contrast, MMP-2/9 sensitive ACPPs balanced tumor selectivity with drug efficacy. Intact, ACPPs held conjugated AZD7762 in a pro-drug inactive state that upon tumor microenvironment ACPP cleavage resulted in tumor selective drug accumulation and anti-tumor efficacy in combination with IR. Importantly, a control non-cleavable ACPP-AZD7762 did not improve tumor control with IR, demonstrating the necessity of ACPP cleavage to release active drug. These results highlight the utility of the ACPP technology platform to target amine containing radiosensitizing drugs to tumor tissues based on extracellular protease activity that overcome the limitations of ADC conjugated radiosensitizers. Citation Format: Dina V. Hingorani, Maria F. Camargo, Maryam A. Quraishi, Joseph Aguilera, Stephen R. Adams, Sunil J. Advani. Redirecting tumor extracellular proteases to target radiosensitizer delivery [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6272.

Abstract A063: TAS1553, a novel class of RNR inhibitor, demonstrates synergistic antitumor efficacy in combination with nucleoside analogues

Abstract Background: Ribonucleotide reductase (RNR) is an essential metabolic enzyme that catalyzes a rate-limiting step for de novo dNTP biosynthesis via converting ribonucleotides to deoxyribonucleotides. dNTPs are also supplied through nucleoside salvage pathway in which dNTP is synthesized from extracellular nucleoside. The salvage pathway is also utilized for conversion of several nucleoside analogues to their active metabolites. Given the previous report showing that the inhibition of de novo pathway activates salvage pathway at least in vitro, RNR is considered as a promising target for combination therapy with nucleoside analogues. However, in vivo efficacy of selective RNR inhibitor in combination with nucleoside analogues has not been clarified yet. Previously, we reported a novel class of RNR inhibitor TAS1553, which is a selective and orally available small molecule abrogating protein-protein interaction between RNR subunits. Here, we evaluated the synergistic activity of TAS1553 and several nucleoside analogues in vitro as well as in vivo studies. Material and methods: Antiproliferative activity was assessed by CellTiter-Glo® 2.0 assay. Intracellular and intratumoral ara-CTP amounts were measured by HPLC analysis. Antitumor efficacy was evaluated in athymic nude mice bearing MV-4-11 (human AML) and CFPAC-1 (human pancreatic cancer) cell line. Results: To examine whether TAS1553 plus nucleoside analogues combination shows synergistic efficacy, we evaluated antiproliferative activity of TAS1553 in combination with some nucleoside analogues (cytarabine, gemcitabine, decitabine, and 2F-ara-A) to calculate the combination index (CI). TAS1553 exhibited synergistic antiproliferative activity (CI < 1) against cancer cell lines in combination with all of the tested nucleoside analogues. Then, to analyze the mechanism underlying the synergistic effect, we asked whether treatment with TAS1553 augments the activity of salvage pathway by measuring ara-CTP, which is an active metabolite of cytarabine. The results showed that treatment with TAS1553 significantly increased ara-CTP accumulation in MV-4-11 cells implying that TAS1553 activates nucleoside salvage pathway by inhibiting de novo nucleotide synthesis. Importantly, when analyzing the timing of treatment for the combination, prior or simultaneous treatment with TAS1553 increased ara-CTP amount more than post treatment. Consistently with in vitro result, co-administration of TAS1553 and cytarabine caused significant increase of intratumoral ara-CTP compared with cytarabine administration in MV-4-11 mouse xenograft model. Following this result, the combination of TAS1553 (100 mg/kg/day, q.d.) and cytarabine (10 mg/kg/day, 5 consecutive days) showed superior antitumor efficacy to MV-4-11 tumor than each monotherapy while the combination did not cause intolerable body weight change. Furthermore, TAS1553 also demonstrated the striking anittumor efficacy in combination with gemcitabine (20 mg/kg/day, q.wk.) on CFPAC-1 mouse xenograft model. Conclusions: TAS1553, a novel class of RNR inhibitor, has synergistic antitumor efficacy in combination with nucleoside analogues. These combination therapy could be promising therapeutic options for cancer patients. Citation Format: Takuya Hoshino, Hiroyuki Ueno, Wakako Yano, Sayaka Tsukioka, Seiji Miyahara, Takamasa Suzuki, Kazutaka Miyadera, Teruhiro Utsugi, Takeshi Sagara. TAS1553, a novel class of RNR inhibitor, demonstrates synergistic antitumor efficacy in combination with nucleoside analogues [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A063. doi:10.1158/1535-7163.TARG-19-A063

Abstract 3945: The folate pathway inhibitor pemetrexed pleiotropically enhances effects of cancer immunotherapy via immunogenic tumor cell death and T cell-intrinsic mechanisms

Abstract Combination strategies leveraging chemotherapy and immunotherapy have held the promise as a method to improve benefit to cancer patients. However, most chemotherapies have detrimental effects on immune homeostasis and do not induce immunogenic cell death. The positive phase III trial of pemetrexed/carboplatin with the PD-1 antibody pembrolizumab in NSCLC (Keynote-189) lead to the first chemotherapy/immunotherapy combination ever approved. While this suggests a positive interaction between pemetrexed-based chemotherapy and PD-1 therapy, the underlying mechanism is unknown. Therefore, it is important to understand the role of pemetrexed in modulating antitumor immune response to assure application of this therapy to the appropriate patients. To characterize the effects of pemetrexed on intra-tumor immune response, murine tumor models which were sensitive to pemetrexed and known to be sensitive to PD-L1, were treated with pemetrexed with or without carboplatin, or anti-mouse PD-L1. In MC38 tumors, pemetrexed monotherapy demonstrated a trend towards an increased frequency of intra-tumor leukocytes that was accompanied by immune-related gene expression changes indicative of enhanced T cell infiltration and/or activation. Gene expression induced by pemetrexed was largely unaffected by carboplatin. Treatment of both MC38 and Colon26 tumor cells in vitro with pemetrexed induced release of HMGB1, indicative of immunogenic cell death. Although proliferation of primary human T cells was slightly reduced by pemetrexed, at clinically relevant concentrations, treatment lead to an enhanced T cell activation phenotype, including upregulation of multiple interferon gamma-induced genes, and increased mitochondrial respiration. This correlated with improved antigen specific in vitro cytotoxic activity of OT-1 TCR transgenic CD8 T cells when treated with pemetrexed during priming with OVA peptide. Treatment with pemetrexed and PD-L1 demonstrated a combination benefit compared to either monotherapy in both tumor models. Pathway Analysis of gene expression data revealed that improved antigen presentation, enhanced T cell and cytokine signaling and an engagement of CD4+ T cell-mediated immunity during the combination. This correlated with upregulation of MHC-I & II on monocytes, macrophages and tumor cells, suggesting increased immune priming. Accordingly, treatment with S1P1R antagonist (FTY720, preventing T cell LN egress) after initiation of therapy resulted in a loss of combination efficacy. This data suggests that pemetrexed promotes intra-tumor T cell-mediated immune response through immunogenic tumor cell death and increased activation and metabolic fitness of T cells. The combination of these effects results in enhanced T cell function leading to an improved anti-tumor efficacy in combination with PD-L1 antibody Citation Format: David A. Schaer, Nelusha Amaladas, Zhao Hai Lu, Erik Rasmussen, Andreas Sonyi, Darin Chin, Andrew Capen, Yanxia Li, Catalina Meyer, Bonita Jones, Xiaodong Hong, Shuang Luo, Carmine Carpenito, Kenneth Roth, Alexander Nikolayev, Bo Tan, Manisha Brahmachary, Krishna Chodavarapu, Frank Charles Dorsey, Jason Manro, Thompson Doman, Greg Donoho, David Surguladze, Gerald Hall, Sandaruwan Geeganage, Michael Kalos, Ruslan Novosiadly. The folate pathway inhibitor pemetrexed pleiotropically enhances effects of cancer immunotherapy via immunogenic tumor cell death and T cell-intrinsic mechanisms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3945.

Oncolytic adenovirus: A tool for cancer therapy in combination with other therapeutic approaches.

Cancer therapy using oncolytic viruses is an emerging area, in which viruses are engineered to selectively propagate in tumor tissues without affecting healthy cells. Because of the advantages that adenoviruses (Ads) have over other viruses, they are more considered. To achieve tumor selectivity, two main modifications on Ads genome have been applied: small deletions and insertion of tissue- or tumor-specific promoters. Despite oncolytic adenoviruses ability in tumor cell lysis and immune responses stimulation, to further increase their antitumor effects, genomic modifications have been carried out including insertion of checkpoint inhibitors and antigenic or immunostimulatory molecules into the adenovirus genome and combination with dendritic cells and chemotherapeutic agents. This study reviews oncolytic adenoviruses structures, their antitumor efficacy in combination with other therapeutic strategies, and finally challenges around this treatment approach.

Synergistic antitumoral efficacy of a novel replicative adenovirus SG611-PDCD5 and daunorubicin in human leukemic cells.

BackgroundDaunorubicin is a traditional chemotherapeutic agent that plays a pivotal role in leukemia therapy. However, the dose-related toxicity remains a considerable challenge. The apoptosis-regulating gene, PDCD5, is downregulated in various tumors, including leukemias, and may provide a potential target for the diagnosis and treatment of leukemia. The purpose of this study was to construct a triple-regulated oncolytic adenovirus carrying a PDCD5 gene expression cassette (SG611-PDCD5) and explore the combined antitumor efficacy of SG611-PDCD5 in combination with low dose daunorubicin on leukemic cells.Materials and methodsA variety of leukemic cell lines, including K562, MEG-01, KG-1a, HL-60, SUP-B15, and BV-173, were cultured according to the providers’ instructions. The insertion and orientation of all recombined plasmids were confirmed by restriction enzyme digestion and PCR. The tumor-selective replication of the constructed conditionally replicating SG611-PDCD5 and its antitumor efficacy in combination with daunorubicin were characterized in leukemic cell lines in vitro and in a nude mouse xenograft model. Cell viability was detected using cell-counting kit-8. Apoptosis was detected in whole living cells using flow cytometry and in paraffin-embedded tumor tissues using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.ResultsThe triple-regulated CRAd carrying SG611-PDCD5 and nude mouse xenograft models of K562 cells were successfully constructed. In vitro treatment with SG611-PDCD5 in combination with low-dose daunorubicin elicited more potent anti-proliferative and proapoptotic effects in leukemic cells in a dose-dependent manner. The Chou-Talalay analysis revealed synergistic anti-proliferative effects in all of the above cell lines. In the nude mice xenograft model, the tumor size in the control, daunorubicin, SG611-PDCD5, and combined treatment groups on day 10 were 170.1±47.8, 111.9±81.1, 60.7±12.3, and 33.2±17.5 mm3, respectively (all P<0.05). The results of the TUNEL assay showed significantly more apoptotic cells in the SG611-PDCD5 plus daunorubicin group than in the SG611-PDCD5 or daunorubicin groups alone (25±0.82, 12.5±2.27, and 7.8±2.67 apoptotic cells/field, respectively) (P<0.05).ConclusionThe findings suggest that combined treatment with SG611-PDCD5 and daunorubicin may be a promising strategy for enhancing chemosensitivity and thus lowering the dose-related toxicity of daunorubicin in leukemia therapy.

Abstract 5621: FAP-4-1BBL: A novel versatile tumor-stroma targeted 4-1BB agonist for combination immunotherapy with checkpoint inhibitors, T-cell bispecific antibodies, and ADCC-mediating antibodies

Abstract For tumor specific co-stimulation via 4-1BB (CD137) a novel tumor-stroma targeted FAP-4-1BB ligand (FAP-4-1BBL) was designed composed of a trimeric split 4-1BBL, a tumor-stroma targeted 4B9 Fab moiety recognizing fibroblast activation protein (FAP) and a heterodimeric Fc-region devoid of FcgR binding but maintained FcRn binding. In presence of a TCR signal 1 either from a T cell receptor MHCI/peptide interaction or through TCR engagement by a T-cell bispecific antibody, FAP-4-1BBL provides co-stimulation to T cells strictly dependent on cross-linking by FAP-expressing fibroblasts. Similarly, FAP-4-1BBL can provide co-stimulation to NK cells with activated FcgRIIIa signaling. FAP-4-1BBL was tested as monotherapy and combined with CEA-TCB, an anti-CEA T-cell bispecific antibody, in the s.c. gastric MKN45 xenograft model co-grafted with NIH-3T3 fibroblasts in human stem cell engrafted (HSC) NSG mice in comparison to DP47-4-1BBL, an analogous untargeted 4-1BBL fusion protein. For use in syngeneic mouse models in immunocompetent mice muFAP-4-1BB, a murine surrogate made of a mu4-1BB agonistic surrogate antibody fused to the variable region of the FAP antibody 4B9, was used. muFAP-4-1BB was tested as monotherapy and combined with a murine specific CEA-TCB surrogate (muCEA-TCB) and the muPD-L1 specific surrogate antibody 6E11 in the s.c. colorectal MC38-CEA model in CEA transgenic (Tg) C57BL/6 mice. For combination with ADCC-mediating antibodies FAP-mu4-1BBL, a hybrid FAP-mu4-1BBL fusion protein, was generated. FAP-mu4-1BBL was tested as monotherapy and combined with the ADCC-mediating anti-HER2 antibody trastuzumab in the s.c. gastric N87 xenograft model in human CD16 Tg Scid mice. In the s.c. gastric MKN45 xenograft model co-grafted with NIH-3T3 fibroblasts in HSC-NSG mice FAP-4-1BBL resulted in combined anti-tumoral efficacy in combination with CEA-TCB, whereas the respective monotherapies as well as the combination with the untargeted DP47-4-1BBL did not improve anti-tumor efficacy. In the syngeneic s.c. MC38-CEA model in CEA Tg C56BL/6 mice, a model with natural FAP expression due to fibroblast infiltration, the muFAP-4-1BB surrogate antibody resulted in combined anti-tumor efficacy, both combined with muCEA-TCB and muPD-L1 antibodies including the induction of tumor remission. Finally, the hybrid FAP-mu4-1BBL surrogate resulted in improved anti-tumor efficacy combined with the ADCC-mediating antibody trastuzumab in the s.c. gastric N87 xenograft model in human CD16 Tg Scid mice. These data show that FAP-4-1BBL is a versatile combination partner for cancer immunotherapy mediating FAP-dependent co-stimulation to T and NK cells in combination with PD-L1 checkpoint inhibition, TCBs and ADCC-mediating antibodies. Clinical evaluation of this novel therapeutic approach is planned early 2018. Citation Format: Johannes Sam, Christina Claus, Claudia Ferrara, Sabine Lang, Valeria Nicolini, Sara Colombetti, Volker Teichgräber, Stefan Evers, Marina Bacac, Pablo Umana, Christian Klein. FAP-4-1BBL: A novel versatile tumor-stroma targeted 4-1BB agonist for combination immunotherapy with checkpoint inhibitors, T-cell bispecific antibodies, and ADCC-mediating antibodies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5621.

Abstract 4845: Preclinical evaluation of HWH340, a novel PARP inhibitor

Abstract Objective: Poly-ADP-ribose polymerase (PARP) participates in DNA repair, replication and transcription, and is important to maintaining genome stability and integrity. PARP inhibitors have proven to be efficacious in the clinic to treat BRCA-deficient cancers. PARP inhibitors may also be used as sensitizing agent in combination with other antitumor agents. The purpose of this study is to investigate in preclinical models the antitumor activity of HWH340, a novel potent and selective PARP inhibitor currently undergoing clinical investigation. Method: HWH340 was evaluated for its PARP1/2 enzymatic activity in corresponding enzyme assays and its cellular PARylation inhibitory activity in HCC1937 cells. The anti-proliferative activity and the synergistic effect in combination with temozolamide (TMZ) were evaluated in vitro in a BRCA-deficient cell line MDA-MB-436 and BRCA proficient cell line MDA-MB-231. Antitumor activity was evaluated by daily oral administration of in xenograft tumor models. Synergistic effect in combination with TMZ was also determined. The animal models used were PARP highly expressed patient-derived xenograft (PDX) model of small cell lung cancer (SCLC) LU-01-0547 and BRCA1/2-deficient CDX models of breast cancer MDA-MB-436 and pancreatic cancer CAPAN-1. Result: HWH340 displayed potent PARP1/2 enzymatic inhibitory activity with IC50 1.14 nM and 1.72 nM respectively. It also potently inhibited cellular PARylation in HCC1937 cell with IC50 2.77 nM. In BRCA proficient cell line MDA-MB-231, HWH340 showed no synergistic effect when combined with TMZ and a weak anti-proliferative activity with IC50 5.83 uM and 4.86 uM. In contrast, it displayed potent anti-proliferative activity and a synergistic effect in combination with TMZ with IC50 of 71 nM and 7 nM in the BRCA1/2-deficient MDA-MB-436 cells, respectively. HWH340 showed excellent in vivo antitumor efficacy in PARP overexpressed SCLC LU-01-0547 PDX model (TGI=81.69%@50mpk, QD). In BRCA-deficient breast cancer MDA-MB-436 CDX model, HWH340 showed potent antitumor efficacy as single agent (TGI=122% @12.5mpk, QD). In BRCA-deficient pancreatic cancer CAPAN-1 CDX model, it showed potent antitumor efficacy in combination with TMZ (TGI=79.61% @25mpk+ TMZ 30mpk, QD). Conclusion: HWH340 is a potent PARP inhibitor. Its antitumor activity in the preclinical tumor models together with its excellent pharmaceutical properties provide confidence that HWH340 may have high potential in the clinic for treatment of BRCA deficient solid cancers. Citation Format: Wenjie Sun, Yang Yue, Hailiang Chen, Ronghua Tu, Jie Shen, Gang Li, Guoqiang Ma, Zhixiang Zhang, Charles Z. Ding, Shuhui Chen. Preclinical evaluation of HWH340, a novel PARP inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4845.

Abstract A169: Combination of TPC-144, a reversible LSD1 inhibitor, and a hypomethylating agent resulted in synergistic antitumor efficacy in preclinical models of AML

Abstract Background: Lysine-specific demethylase 1A (LSD1/KDM1A) is a flavin adenine dinucleotide (FAD)-dependent histone demethylase that specifically modifies histone H3 lysine 4 and lysine 9. LSD1 activity is implicated in the pathogenesis of several human cancers, and recent studies indicated that the inhibition of LSD1 is a promising therapeutic strategy for acute myeloid leukemia (AML). Decitabine and azacitidine, FDA-approved agents for the treatment of AML and myelodysplastic syndrome, alter global DNA methylation by inhibiting DNA methyltransferases (DNMTs), resulting in apoptosis and differentiation. Since it is reported that LSD1 directly demethylates and stabilizes DNMT1 by protection from degradation, we hypothesized that an LSD1 inhibitor could augment anti-AML activity of DNMT inhibitors. Previously, we demonstrated that TPC-144, a novel reversible LSD1 inhibitor, was efficacious in preclinical models of AML. Here, we report the activity of TPC-144 in combination with decitabine in cell-based and in vivo studies. Material and Methods: In vitro studies on growth inhibition and apoptosis were conducted using AML cell lines by measuring cellular ATP content (Cell-Titer Glo, Promega) and sub-G1 population, respectively. For expression changes of surface markers, cells were stained with specific antibodies (BD Pharmingen) and analyzed by flow cytometry. mRNA levels of LSD1 target genes were quantitated by real-time PCR. LINE-1 methylation levels were evaluated in Global DNA Methylation-LINE-1 Kit (Active Motif). In vivo efficacy was evaluated in human AML xenograft models in SCID mice. TPC-144 and decitabine was administered orally or intraperitoneally, respectively. Results: The combination of TPC-144 and decitabine showed synergistic growth inhibition of human AML cells in vitro. TPC-144 enhanced apoptosis induction in combination with low-dose decitabine at the concentrations at which TPC-144 decreased DNMT1 protein levels and LINE-1 methylation levels. Combination treatment strongly increased expression of surface markers of differentiation such as CD86 and CD11b, compared with single-agent treatment. In AML xenograft models, the combination of TPC-144 and decitabine was tolerated without signs of hematopoietic toxicities, and demonstrated curative antitumor efficacy compared with each inhibitor alone in a decitabine-sensitive xenograft model. Importantly, the combination treatment of TPC-144 and decitabine exhibited strong antitumor efficacy even in a decitabine-insensitive AML model. Conclusions: TPC-144, a novel potent and selective reversible LSD1 inhibitor, demonstrated synergistic antitumor efficacy in combination with decitabine in human AML cell lines and xenograft models. This combination was well tolerated and showed strong efficacy not only in decitabine-sensitive but also in decitabine-insensitive AML models. Therefore, combination of TPC-144 and decitabine could enhance their therapeutic value for the treatment of AML patients. Citation Format: Akiko Osada, Aki Kawagishi, Ryo Hatanaka, Takumitsu Machida, Kenjiro Ito, Satoshi Yamashita, Takahiro Ogawa, Tadashi Imaoka, Kenichi Matsuo, Teruhiro Utsugi, Yoshikazu Iwasawa. Combination of TPC-144, a reversible LSD1 inhibitor, and a hypomethylating agent resulted in synergistic antitumor efficacy in preclinical models of AML [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A169.

Granulocyte-Colony Stimulating Factor Nanocarriers for Stimulation of the Immune System (Part II): Dose-Dependent Biodistribution and In Vivo Antitumor Efficacy in Combination with Rituximab.

The purpose of immuno-modulation is to increase or restore the action of immunocompetent cells against tumors with or without the use of monoclonal antibodies. The innate immune system is a key player in various pathological situations, but cells of this system appear to be inhibited or insufficiently active in malignancy or severe infectious diseases. The present study was designed to investigate therapeutic value of nanoparticles (NPs) coupled with bioactive hematopoietic growth factors acting on the innate immune system. The use of nanoparticles (NPs) allowing multimodal detection and multifunctional grafting are currently of great interest for theranostic purposes. In the present work, we have evaluated the impact of the number of granulocyte-colony stimulating factor (G-CSF) grafted on the surface on the NPs on the biodistribution in mice thanks to indium 111 radiolabeling. Furthermore, we have investigated whether grafted G-CSF NPs could stimulate the immune innate system and enhance the therapeutic efficacy of the monoclonal antibody rituximab in mice bearing human lymphoma xenografts. Following intravenous (i.v.) administration of NP-DTPA and NP-DTPA/G-CSF-X high levels of radioactivity were observed in the liver. Furthermore, spleen uptake was correlated with the number of G-CSF molecules grafted on the surface of the NPs. Combining NP-DTPA/G-CSF-34 with rituximab strongly reduced RL tumor growth compared to rituximab alone or in combination with conventional G-CSF + rituximab. The use of highly loaded G-CSF NPs as immune adjuvants could enhance the antitumor activity of therapeutic monoclonal antibodies by amplifying tumor cell destruction by innate immune cells.

Multi-modal Potentiation of Oncolytic Virotherapy by Vanadium Compounds.

Oncolytic viruses (OV) are an emerging class of anticancer bio-therapeutics that induce antitumor immunity through selective replication in tumor cells. However, the efficacy of OVs as single agents remains limited. We introduce a strategy that boosts the therapeutic efficacy of OVs by combining their activity with immuno-modulating, small molecule protein tyrosine phosphatase inhibitors. We report that vanadium-based phosphatase inhibitors enhance OV infection invitro and exvivo, in resistant tumor cell lines. Furthermore, vanadium compounds increase antitumor efficacy in combination with OV in several syngeneic tumor models, leading to systemic and durable responses, even in models otherwise refractory to OV and drug alone. Mechanistically, this involves subverting the antiviral type I IFN response toward a death-inducing and pro-inflammatory type II IFN response, leading to improved OV spread, increased bystander killing of cancer cells, and enhanced antitumor immune stimulation. Overall, we showcase a new ability of vanadium compounds to simultaneously maximize viral oncolysis and systemic anticancer immunity, offering new avenues for the development of improved immunotherapy strategies.