You have accessJournal of UrologyCME1 May 2022MP06-13 TARGETING THE ANDROGEN RECEPTOR AXIS TO IMPROVE RESPONSE TO BLADDER CANCER IMMUNOTHERAPY Typhaine Gris, Marjorie Besançon, France-Hélène Joncas, Valérie Picard, Alain Bergeron, Yves Fradet, and Paul Toren Typhaine GrisTyphaine Gris More articles by this author , Marjorie BesançonMarjorie Besançon More articles by this author , France-Hélène JoncasFrance-Hélène Joncas More articles by this author , Valérie PicardValérie Picard More articles by this author , Alain BergeronAlain Bergeron More articles by this author , Yves FradetYves Fradet More articles by this author , and Paul TorenPaul Toren More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002523.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men are 3-4 times more likely to be diagnosed with bladder cancer (BCa) than women, who often have more aggressive tumors. Intravesical instillation of BCG is one of the first immunotherapies in widespread use and is given to patients with non-muscle invasive bladder cancer (NMIBC). Newer PD-1/PD-L1 checkpoint inhibitors now also have proven efficacy against BCa. Nonetheless, approximately 35% of patients fail to respond to BCG, with response rates to checkpoint immunotherapy much lower. Based on prior work suggesting the importance of the androgen receptor (AR) in BCa, we investigated AR-targeting as a novel strategy to improve the response to BCa immunotherapy in the MBT-2 murine BCa model. METHODS: Subcutaneous injection of 106 MBT-2 cells into male and female C3H mice was performed, with tumors harvested at tumor size limits. The AR antagonist enzalutamide (ENZ) was given in alone or combination with anti-PD-1 or intra-tumoral BCG treatments as previously described. Selected human NMIBC were collected following transurethral resection. After digestion of fresh human and murine tumors, flow cytometry analyses characterized the immune cells present. The anti-proliferative effect of AR antagonists against human and murine BCa cell lines was tested in vitro. RESULTS: The CD45+/CD45- ratio, extent of tumor infiltrating lymphocytes, and expression of immune checkpoint markers from the MBT-2 model is comparable to the immune composition of NMIBC tumors resected from patients. Moreover, the model also recapitulates previously observed human tumor immune cell gender differences. AR antagonist ENZ demonstrated anti-proliferative effects in lower grade human and murine BCa cell lines, while limited differences were seen in human high grade BCa cell lines. While ENZ alone had no effect in vivo, its use in combination with either anti-PD-1 or BCG treatment in male mice synergized to improve response rates. Complete response was confirmed by re-challenge of mice, demonstrating immune memory. Notably, the proportion of complete responses in male mice treated with the combination treatment is similar to that observed in female mice with either immunotherapy alone. Flow cytometry analyses showed that these therapeutic benefits in male mice are related to an increase in pro-inflammatory tumor infiltrating dendritic cells as well as a decrease in anti-inflammatory tumor infiltrating dendritic cells and myeloid-derived suppressor cells. CONCLUSIONS: Our results suggest that combining AR antagonism with immunotherapy in male BCa patients may potentiate the antitumor immune response and increase response rates. Accordingly, a Phase II trial to evaluate the efficacy of AR antagonism in combination with BCG to decrease NMIBC tumor recurrences in men is planned. Further, the MBT-2 murine model appears relevant to investigate immunologic BCa sex differences. Source of Funding: Cancer Research Society (Upcycle Grant) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e82 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Typhaine Gris More articles by this author Marjorie Besançon More articles by this author France-Hélène Joncas More articles by this author Valérie Picard More articles by this author Alain Bergeron More articles by this author Yves Fradet More articles by this author Paul Toren More articles by this author Expand All Advertisement PDF DownloadLoading ...
Read full abstract