Outcome Of Cancer Immunotherapy Research Articles

Sex Disparities in Cancer Immunotherapy: A Review

Cancer immunotherapy has revolutionized cancer treatment, particularly through immune checkpoint inhibitors (ICIs) targeting proteins like PD-1, PD-L1, and CTLA-4. While these therapies have shown significant survival benefits across various cancers, sex-based disparities in treatment response and outcomes have emerged. This review explores the mechanisms behind these differences, focusing on genetic, hormonal, and immune system variations between male and female patients. Women tend to exhibit stronger immune responses due to the presence of two X chromosomes and the immunostimulatory effects of estrogen, which enhances immune activity. Conversely, men’s single X chromosome and the immunosuppressive effects of testosterone contribute to a less vigorous immune response. These biological differences manifest in clinical outcomes, with men generally experiencing better overall survival rates from ICIs, while women are more prone to immune-related adverse events (irAEs), including autoimmune toxicities. However, in certain cases, women may demonstrate more robust long-term survival benefits from treatments such as CTLA-4 inhibitors, despite higher toxicity risks. Beyond ICIs, sex disparities also extend to adoptive cell therapies (ACT) and cancer vaccines, where female patients often display stronger immune responses but face increased risks of side effects, necessitating personalized approaches to therapy. The review also discusses emerging research on the tumor microenvironment (TME), gut microbiome, and sex-specific pharmacokinetics and pharmacodynamics as contributing factors to these disparities. Understanding these mechanisms is critical for improving cancer immunotherapy outcomes for both sexes. Future research should focus on investigating the role of sex hormones, the microbiome, and developing biomarkers to better predict responses to immunotherapy. Clinically, the findings highlight the need for tailored treatment strategies that account for sex-specific differences, aiming for more equitable and effective cancer care. Keywords: Cancer immunotherapy, Immune checkpoint inhibitors (ICIs), Sex-based disparities, PD-1 inhibitors, PD-L1 inhibitors, CTLA-4 inhibitors

Somatic mutational landscape reveals mutational signatures and significantly mutated genes of cancer immunotherapeutic outcome and sex disparities

BackgroundCurrently developed molecular markers can predict the effectiveness of cancer immunotherapy and screen beneficiaries to some extent, but they are not stable enough. Therefore, there is an urgent need for discovering novel biomarkers. At the same time, sex factor plays a vital role in the response to immunotherapy, so it is particularly important to identify sex-related molecular indicators.MethodsWe integrated a pan-cancer cohort consisting of 2348 cancer patients who received immune checkpoint inhibitors and targeted sequencing. Using somatic mutation profiles, we identified mutational signatures, molecular subtypes, and frequently mutated genes, and analyzed their relationships with immunotherapeutic outcomes. We also explored sex disparities of determined biomarkers in response to treatments.ResultsWe found that male patients exhibited better immunotherapy outcomes and higher tumor mutational burden. A total of seven mutational signatures were identified, among which signatures 1 and 3 were associated with worse immunotherapy outcomes, while signatures 2 and 6 correlated with better outcomes. Gender-based analysis revealed that mutational signature 1 continued to show a worse immunotherapy outcome in female patients, whereas signature 6 demonstrated a better outcome in male patients. Based on mutational activities, we identified four potential molecular subtypes with gender differences and relevance to treatment outcomes. PI3K-AKT, RAS signaling pathways, and 68 significantly mutated genes were identified to be associated with immunotherapy outcomes, with nine genes (i.e., ATM, ATRX, DOT1L, EP300, EPHB1, NOTCH1, PBRM1, RBM10, and SETD2) exhibiting gender differences. Finally, we discovered co-mutated gene pairs and TP53 p.R282W mutations related to treatment outcomes, highlighting their gender-specific differences.ConclusionThis study identified several molecular biomarkers related to cancer immunotherapy outcomes in terms of mutational signatures, molecular subtypes, and mutated genes, and explored their gender-relatedness in order to provide clues and basis for clinical treatment efficacy evaluation and patient selection.

Towards a framework for predicting immunotherapy outcome: a hybrid multiscale mathematical model of immune response to vascular tumor growth.

Studying tumor immune microenvironment (TIME) is pivotal to understand the mechanism and predict the outcome of cancer immunotherapy. Systems biology mathematical models can consider and control various factors of TIME and therefore explore the anti-tumor immune response meticulously. However, the role of tumor vasculature in the recruitment of T cells and the mechanism of T cell migration through TIME have not been studied comprehensively. In this work, we developed a hybrid discrete-continuum multi-scale model to study TIME. The mathematical model includes angiogenesis and T cell recruitment via tumor vasculature. Moreover, solid tumor growth, vascular growth and remodeling, interstitial fluid flow, hemodynamics, and blood rheology are all considered in the model. In addition, different aspects of T cells, including their migration, proliferation, subtype conversion, and interaction with tumor cells are thoroughly included. The model reproduces spatiotemporal distribution of tumor infiltrating T cells that mimics histopathological patterns. Furthermore, TIME model robustly recapitulates different phases of tumor immunoediting. We also examined a number of biomarkers to predict the outcome of immune checkpoint blockade (ICB) treatment. The results demonstrated that although tumor mutational burden (TMB) may predict non-responders to ICB, a combination of different biomarkers is essential to predict the majority of the responders. Based on our results, the ICB response rate varies significantly from 28 to 89% depending on the values of different parameters, even in the cases with high TMB.

Berberine sensitizes immune checkpoint blockade therapy in melanoma by NQO1 inhibition and ROS activation

Unprecedented progress in immune checkpoint blockade (ICB) therapy has been made in cancer treatment. However, the response to ICB therapy is limited to a small subset of patients. The development of ICB sensitizers to improve cancer immunotherapy outcomes is urgently needed. Berberine (BBR), a well-known phytochemical compound isolated from many kinds of medicinal plants such as Berberis aristata, Coptis chinensis, and Phellondendron chinense Schneid, has shown the ability to inhibit the proliferation, invasion and metastasis of cancer cells. In this study, we investigated whether BBR can enhance the therapeutic benefit of ICB for melanoma, and explored the underlying mechanisms involved. The results showed that BBR could sensitize ICB to inhibit tumor growth and increased the survival rate of mice. Moreover, BBR stimulated intracellular ROS production partially by inhibiting NQO1 activity, which induced immunogenic cell death (ICD) in melanoma, elevated the levels of damage-associated molecular patterns (DAMPs), and subsequently activated DC cells and CD8 + T cells in vitro and in vivo. In conclusion, BBR is a novel ICD inducer. BBR could enhance the therapeutic benefit of ICB for melanoma. These effects were partially mediated through the inhibition of NQO1 and ROS activation.

Selenium Nanoparticles Synergize with a KRAS Nanovaccine against Breast Cancer.

Selenium (Se) is an element crucial for human health, known for its anticancer properties. Although selenium nanoparticles (SeNPs) have shown lower toxicity and higher biocompatibility than other Se compounds, bare SeNPs are unstable in aqueous solutions. In this study, several materials, including bovine serum albumin (BSA), chitosan, polymethyl vinyl ether-alt-maleic anhydride, and tocopherol polyethylene glycol succinate, are explored to develop stable SeNPs and further evaluate their potential as candidates for cancer treatment. All optimized SeNP are spherical, <100nm, and with a narrow size distribution. BSA-stabilized SeNPs produced under acidic conditions present the highest stability in medium, plasma, and at physiological pH, maintaining their size ≈50-60nm for an extended period. SeNPs demonstrate enhanced toxicity in cancer cell lines while sparing primary human dermal fibroblasts, underscoring their potential as effective anticancer agents. Moreover, the combination of BSA-SeNPs with a nanovaccine results in a strong tumor growth reduction in an EO771 breast cancer mouse model, demonstrating a three-fold decrease in tumor size. This synergistic anticancer effect not only highlights the role of SeNPs as effective anticancer agents but also offers valuable insights for developing innovative combinatorial approaches using SeNPs to improve the outcomes of cancer immunotherapy.

A Bioinformatics Investigation of Hub Genes Involved in Treg Migration and Its Synergistic Effects, Using Immune Checkpoint Inhibitors for Immunotherapies.

This study aimed to identify hub genes involved in regulatory T cell (Treg) function and migration, offering insights into potential therapeutic targets for cancer immunotherapy. We performed a comprehensive bioinformatics analysis using three gene expression microarray datasets from the GEO database. Differentially expressed genes (DEGs) were identified to pathway enrichment analysis to explore their functional roles and potential pathways. A protein-protein interaction network was constructed to identify hub genes critical for Treg activity. We further evaluated the co-expression of these hub genes with immune checkpoint proteins (PD-1, PD-L1, CTLA4) and assessed their prognostic significance. Through this comprehensive analysis, we identified CCR8 as a key player in Treg migration and explored its potential synergistic effects with ICIs. Our findings suggest that CCR8-targeted therapies could enhance cancer immunotherapy outcomes, with breast invasive carcinoma (BRCA) emerging as a promising indication for combination therapy. This study highlights the potential of CCR8 as a biomarker and therapeutic target, contributing to the development of targeted cancer treatment strategies.

Exploring the Role of the Gut Microbiota in Modulating Colorectal Cancer Immunity.

The gut microbiota plays an essential role in maintaining immune homeostasis and influencing the immune landscape within the tumor microenvironment. This review aims to elucidate the interactions between gut microbiota and tumor immune dynamics, with a focus on colorectal cancer (CRC). The review spans foundational concepts of immuno-microbial interplay, factors influencing microbiome composition, and evidence linking gut microbiota to cancer immunotherapy outcomes. Gut microbiota modulates anti-cancer immunity through several mechanisms, including enhancement of immune surveillance and modulation of inflammatory responses. Specific microbial species and their metabolic byproducts can significantly influence the efficacy of cancer immunotherapies. Furthermore, microbial diversity within the gut microbiota correlates with clinical outcomes in CRC, suggesting potential as a valuable biomarker for predicting response to immunotherapy. Conclusions: Understanding the relationship between gut microbiota and tumor immune responses offers potential for novel therapeutic strategies and biomarker development. The gut microbiota not only influences the natural history and treatment response of CRC but also serves as a critical modulator of immune homeostasis and anti-cancer activity. Further exploration into the microbiome's role could enhance the effectiveness of existing treatments and guide the development of new therapeutic modalities.

EBF1-COX4I2 signaling axis promotes a myofibroblast-like phenotype in cancer-associated fibroblasts (CAFs) and is associated with an immunosuppressive microenvironment

Immunotherapy has limited response rates in colorectal cancer (CRC) due to an immunosuppressive tumor microenvironment (TME). Combining transcriptome sequencing, clinical specimens, and functional experiments, we identified a unique group of CAF subpopulations (COX4I2 + ) with inhibited mitochondrial respiration and enhanced glycolysis. Through bioinformatics predictions and luciferase reporter assays, we determined that EBF1 can upstreamly regulate COX4I2 transcription. COX4I2 + CAFs functionally and phenotypically resemble myofibroblasts, are important for the formation of the fibrotic TME, and are capable of activating the M2 phenotype of macrophages. In vitro experiments demonstrated that COX4I2 + CAFs promote immunosuppressive TME by blocking CD8 + T cell infiltration and inducing CD8 + T cell dysfunction. Using multiple independent cohorts, we also found a strong correlation between the immunotherapy response rate of CRC patients and COX4I2 expression in their tumors. Our results identify a CAF subpopulation characterized by activation of the EBF1-COX4I2 axis, and this group of CAFs can be targeted to improve cancer immunotherapy outcomes.

Eosinophil-Activating Semiconducting Polymer Nanoparticles for Cancer Photo-Immunotherapy.

Eosinophils are important immune effector cells that affect T cell-mediated antitumor immunity. However, the low frequency and restrained activity of eosinophils restricted the outcome of cancer immunotherapies. We herein report an eosinophil-activating semiconducting polymer nanoparticle (SPNe) to improve photodynamic tumor immunogenicity, modulate eosinophil chemotaxis, and reinvigorate T-cell immunity for activated cancer photo-immunotherapy. SPNe comprises an amphiphilic semiconducting polymer and a dipeptidyl peptidase 4 (DPP4) inhibitor sitagliptin via a 1O2-cleavable thioketal linker. Upon localized NIR photoirradiation, SPNe generates 1O2 to elicit immunogenic cell death of tumors and induce specific activation of sitagliptin. The subsequent inhibition of DPP4 increases intratumoral CCL11 levels to promote eosinophil chemotaxis and activation. SPNe-mediated photo-immunotherapy synergized with immune checkpoint blockade greatly promotes tumor infiltration and activation of both eosinophils and T cells, effectively inhibiting tumor growth and metastasis. Thus, this study presents a generic polymeric nanoplatform to modulate specific immune cells for precision cancer immunotherapy.

Eosinophil‐Activating Semiconducting Polymer Nanoparticles for Cancer Photo‐Immunotherapy

AbstractEosinophils are important immune effector cells that affect T cell‐mediated antitumor immunity. However, the low frequency and restrained activity of eosinophils restricted the outcome of cancer immunotherapies. We herein report an eosinophil‐activating semiconducting polymer nanoparticle (SPNe) to improve photodynamic tumor immunogenicity, modulate eosinophil chemotaxis, and reinvigorate T‐cell immunity for activated cancer photo‐immunotherapy. SPNe comprises an amphiphilic semiconducting polymer and a dipeptidyl peptidase 4 (DPP4) inhibitor sitagliptin via a 1O2‐cleavable thioketal linker. Upon localized NIR photoirradiation, SPNe generates 1O2 to elicit immunogenic cell death of tumors and induce specific activation of sitagliptin. The subsequent inhibition of DPP4 increases intratumoral CCL11 levels to promote eosinophil chemotaxis and activation. SPNe‐mediated photo‐immunotherapy synergized with immune checkpoint blockade greatly promotes tumor infiltration and activation of both eosinophils and T cells, effectively inhibiting tumor growth and metastasis. Thus, this study presents a generic polymeric nanoplatform to modulate specific immune cells for precision cancer immunotherapy.

Single-cell analysis reveals cellular and molecular factors counteracting HPV-positive oropharyngeal cancer immunotherapy outcomes

BackgroundOropharyngeal squamous cell carcinoma (OPSCC) induced by human papillomavirus (HPV-positive) is associated with better clinical outcomes than HPV-negative OPSCC. However, the clinical benefits of immunotherapy in patients with HPV-positive OPSCC...

Association between circulating cytokines expression patterns and outcomes to immune-checkpoint (ICI)–based regimens in metastatic renal cell carcinoma (mRCC).

4547 Background: ICI combinations (combos) in the form of dual ICI or ICI plus tyrosine kinase inhibitors (TKI) combos currently represent the most effective therapies in mRCC patients (pts). However, there is an unmet need to discover biomarkers predictive of clinical benefit to ICI combos. Circulating cytokines are important regulators of the immune system and may contribute to cancer immunotherapy outcomes. In mRCC, prior studies showed that baseline cytokines expression may influences outcomes to ICI monotherapy, but this association is unknown in ICI combos. Herein, we examined the association between circulating cytokines and ICI combos in mRCC. Methods: We prospectively collected baseline blood samples from mRCC pts receiving ICI combos at our institution. Circulating cytokine profile was assessed using a 32-plex cytokine assay. Baseline demographic, clinical characteristics, and treatment outcomes were collected from electronic health record review. IMDC risk categories were determined at ICI combo initiation. Clinical benefit was defined as radiologic partial response, complete response, or stable disease ≥ 12 months. Median cytokine concentration was used to stratify cytokine expression levels (high vs. low). Univariate and multivariate logistic regression was used to evaluate cytokines expression with time to next treatment (TNT). Results: A total of 29 mRCC pts who received ICI combos were included. 76% were men with a median age of 66 years (IQR 37-80) and 69% had clear cell tumors. ICI combos included ICI+ICI in 15 pts (52%) and ICI+TKI in 14 pts (42%). Poor-risk according to IMDC classification was positively associated with IL-6 (p= 0.03) and IL-8 (p=0.01) baseline expression, while intermediate-risk was positively associated with IL-22 expression (p=0.028). 38% of pts had clinical benefit from ICI combos in our cohort. Clinical benefit was negatively associated with IL-8 (p=0.04), IL-10 (p=0.03) and VEGF-alpha (p=0.03) baseline expression. Pts with high IL-6, IL-8, IL-10, and VEGF-Alpha baseline expression had a median TNT of 5.09 vs. 17.32 months (p= 0.07), 5.32 vs. 17.32 months (p =0.09), 5.32 vs. 25.59 months (p=0.04), and 3.77 vs. not reached (NR) (p=0.00), respectively. Among pts with intermediate risk mRCC, those with high VEGF-alpha and IL-6 expression had a median TNT of 5.07 months vs. NR (p=0.00), and 5.32 vs.17.32 month (p=0.002) respectively. In multivariate COX regression analysis VEGF-alpha expression was found to be an independent risk factor for TNT (HR, 2.56, 95% CI, 1.27-5.18; P = 0.009). Conclusions: Baseline expressions of IL-6, IL-8, IL-10 VEGF-alpha, may represent an important prognostic biomarker that can further risk stratify intermediate risk mRCC and predict clinical outcomes to ICI combos. Analysis of the association between ICI combo outcomes and post-treatment cytokine profiles is in progress.

What We Know About the Actual Role of Traditional Probiotics in Health and Disease.

The complex relationship between probiotics and human health goes beyond their traditional function in gut health, generating considerable interest for their broad potential in disease treatment. This review explores the various functions of probiotics, highlighting their impact on the immune system, their benefits for gut and oral health, their effects on metabolic and neurological disorders, and their emerging potential in cancer therapy. We give significant importance to studying the effects of probiotics on the gut-brain axis, revealing new and non-invasive therapeutic approaches for complex neurological disorders. In addition, we expand the discussion to encompass the impact of probiotics on the gut-liver and gut-lung axes, recognizing their systemic effects and potential in treating respiratory and hepatic conditions. The use of probiotic "cocktails" to improve cancer immunotherapy outcomes indicates a revolutionary approach to oncological treatments. The review explores the specific benefits associated with various strains and the genetic mechanisms that underlie them. This study sets the stage for precision medicine, where probiotic treatments can be tailored to meet the unique needs of each patient. Recent developments in delivery technologies, including microencapsulation and nanotechnology, hold great potential for enhancing the effectiveness and accuracy of probiotic applications in therapeutic settings. This study provides a strong basis for future scientific research and clinical use, promoting the incorporation of probiotics into treatment plans for a wide range of diseases. This expands our understanding of the potential benefits of probiotics in modern medicine.

METTL3: Melting the tumor microenvironment for improved immunotherapy

The tumor microenvironment (TME) dictates the outcome of cancer immunotherapy. In this issue of Cell Chemical Biology, Yu etal.1 report that targeting Mettl3 leads to a more inflamed, "hot" TME and effective anti-PD-1 therapy. This study points to a new target in remodeling the TME for improved immunotherapy.

Huang Lian Jie Du Decoction enhances the anti-tumor efficacy of immune checkpoint inhibitors by activating TLR7/8 signalling in melanoma

BackgroundThe clinical application of immune checkpoint inhibitors (ICIs) is limited by their drug resistance, necessitating the development of ICI sensitizers to improve cancer immunotherapy outcomes. Huang Lian Jie Du Decoction (HLJD, Oren-gedoku-to in Japanese, Hwangryunhaedok-tang in Korean), a famous traditional Chinese medicinal prescription, has exhibited potential in the field of cancer treatment. This study aims to investigate the impact of HLJD on the efficacy of ICIs in melanoma and elucidate the underlying mechanisms.MethodsThe potential synergistic effects of HLJD and ICIs were investigated on the tumor-bearing mice model of B16F10 melanoma, and the tumor infiltration of immune cells was tested by flow cytometry. The differential gene expression in tumors between HLJD and ICIs group and ICIs alone group were analyzed by RNA-seq. The effects of HLJD on oxidative stress, TLR7/8, and type I interferons (IFN-Is) signaling were further validated by immunofluorescence, PCR array, and immunochemistry in tumor tissue.ResultsHLJD enhanced the anti-tumor effect of ICIs, significantly inhibited tumor growth, and prolonged the survival duration in melanoma. HLJD increased the tumor infiltration of anti-tumor immune cells, especially DCs, CD4+ T cells and CD8+T cells. Mechanically, HLJD activated the oxidative stress and TLR7/8 signaling pathway and IFN-Is-related genes in tumors.ConclusionsHLJD enhanced the therapeutic benefits of ICIs in melanoma, through increasing reactive oxygen species (ROS), promoting the TLR7/8 pathway, and activating IFN-Is signaling, which in turn activated DCs and T cells.

Abstract SY38-01: Diverse effects of obesity on cancer immunology and therapy: Both the good and the bad

Abstract Obesity (BMI of 30 or higher) has reached pandemic proportions in the US and continues to rise. Obesity is associated with increased cancer incidence, progression, and mortality. Obesity is also associated with a meta-inflammation as well as general immune suppression. However, we and others have observed in both preclinical models involving diet-induced obese (DIO) mice as well as clinical cancer outcomes, that obesity can be associated with increased efficacy and T cell responses following immune checkpoint inhibition (ICI) targeting PD-1/PDL-1 (Wang Z et al, Nat Med 2019). This protective effect in preclinical models occurred despite marked increased tumor growth and progression in DIO mice. The results indicated that an “obesity paradox” existed regarding some cancer immune therapies. However, this increased efficacy did not apply to all immune therapy responses as we have also observed that following strong systemic immunostimulatory regimens such as with high dose cytokines (IL2) or following an allogeneic hematopoietic stem cell transplant (HSCT), that obesity was correlated with poorer outcomes due to increased cytokine release syndrome (CRS) due to macrophage dysregulation, reduction in gut microbiome diversity, and increased gut permeability, in both preclinical models and clinical outcomes (Khuat LT et al, Sci Trans Med 2020). These results indicated that a balance exists between the positive and negative effects of obesity which could be contingent on the particular type of cancer immunotherapy applied. With ICI, obesity is beneficial, but strong systemic immunostimulatory therapies can result in heightened proinflammatory responses and pathologies. It has also been reported that sex differences regarding the obesity paradox may also occur with high BMI males demonstrating increased anti-tumor efficacy (McQuade JL et al, Lancet Oncol 2018). The physiology of obesity regarding adiposity deposition and metabolic perturbations are also affected by sex hormones and obesity can also have marked effects on both androgen and estrogen production. We therefore assessed the role of sex on different cancer immunotherapy outcomes in obesity. Following systemic cytokine application or after allogeneic HSCT, no differences were observed between male and female DIO mice regarding the increased toxicities due to CRS. In marked contrast, following ICI targeting PD-1, increased anti-tumor effects were only observed in male and not female DIO mice. This was associated with immune differences in which female DIO mice had higher myeloid derived suppressor cells (MDSCs) and decreased T cell responses. However, when female mice were ovariectomized before placed on diet, application of ICI now resulted in increased anti-tumor efficacy comparable to DIO males. Importantly, metabolomics indicated that key metabolite changes could be correlated with the return of responsiveness. Similarly, clinical outcomes stratified on both sex and BMI also demonstrated the increased efficacy following ICI in high BMI males. These results demonstrate that sex-linked differences exist regarding the effects obesity has on cancer immunotherapy outcome following ICI but not other types of immune therapies. Further, these sex-based differences in obesity can be correlated with immunological alterations, and these can be reversed by estrogen inhibition suggesting that hormone modulation may offer immunological benefits in the context of obesity following cancer immunotherapy involving ICI. Citation Format: William J. Murphy, Logan Vick, Robert Canter, Spencer Rosario, Arta Monjazeb. Diverse effects of obesity on cancer immunology and therapy: Both the good and the bad [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr SY38-01.

Association of pretreatment neutrophil-to-lymphocyte ratio with clinical outcomes in cancer immunotherapy: An evidence synthesis from 30 meta-analyses

BackgroundThe Neutrophil-to-lymphocyte ratio (NLR) holds relevance in cancer immunotherapy outcomes, yet its validation remains limited. Thus, we conducted an umbrella review to comprehensively assess the association between pretreatment NLR and immunotherapy outcomes, along with evaluating their credibility and strength. MethodsElectronic databases, including PubMed, Web of Science, Embase, Scopus, and Cochrane, were systematically searched for eligible systematic reviews and meta-analyses. Quality assessment and evidence grading utilized AMSTAR, GRADE, and additional classification criteria, following PRISMA and PRIOR guidelines. ResultsThirty unique meta-analyses were included, with 24 associations (80%) exhibiting statistical significance. Notably, associations between pretreatment NLR and the prognosis of renal cell carcinoma, hepatocellular carcinoma, melanoma, and non-small cell lung cancer garnered highly suggestive or convincing evidence grading. ConclusionsElevated pretreatment NLR correlates with poor outcomes in cancer immunotherapy, suggesting its potential as a biomarker for identifying appropriate treatment populations and predicting clinical outcomes. Nevertheless, further validation through prospective cohort studies is warranted.

Abstract 2459: ADT-030 is a novel dual-acting RAS/β-catenin inhibitor that potentiates antitumor immunity

Abstract ADT-030 is a novel indene identified from a screening campaign and chemically optimized for drug-like properties that acts as a dual inhibitor of RAS and β-catenin signaling. Here we demonstrate that ADT-030 binds RAS with high affinity and inhibits MAPK/AKT signaling with high potency and selectivity in KRAS mutant cells to inhibit proliferation and induce apoptosis. ADT-030 also inhibits phosphodiesterase 10A (PDE10) that is overexpressed in cancer cells to selectively activate cyclic guanosine monophosphate (cGMP)/protein kinase G (PKG) signaling, which induces phosphorylation and degradation of the oncogenic pool of β-catenin. ADT-030 exhibited cytotoxicity to a variety of murine cancer cell lines in vitro, and inhibited tumor growth in syngeneic immunocompetent mice when orally administered. The antitumor activity of ADT-030 was diminished in mice that were immunodeficient or depleted of CD8+ T cells, indicating a critical role of the host immune system. In a metastatic breast tumor mouse model (4T1), ADT-030 not only delayed the growth of the primary tumor but also reduced tumor colonization in the lungs, leading to increased survival. CyTOF and scRNAseq analyses provided a plethora of information revealing the impact of ADT-030 on the immune milieu in the tumor microenvironment. Notably, ADT-030 selectively induced apoptosis of myeloid-derived suppressor cells (MDSCs) while CD8+ T cells were not affected. Consequently, ADT-030 treatment resulted in a marked reduction of MDSCs, which was accompanied by increased tumor infiltration of effector CD8+ T cells. ADT-030 treatment of cancer cells led to immunogenic cell death and enhanced dendritic cell activation. Furthermore, the ability of ADT-030 to augment the antitumor activity of immune checkpoint blockade therapy underlines its potential as a desirable immune-potentiating agent to improve the outcome of cancer immunotherapy. ADT-030 represents a development candidate ready for IND-enabling safety assessment. Citation Format: Md Yeashin Gazi, Ogacheko Okoko, Xin Wang, Caitlin Brandle, Xi Chen, Khalda Fadlalla, Adam Keeton, Yulia Maxuitenko, Catherine Hedrick, Huidong Shi, Gary Piazza, Gang Zhou. ADT-030 is a novel dual-acting RAS/β-catenin inhibitor that potentiates antitumor immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2459.

Abstract 3255: Targeting CD4+FOXP3+ Tregs to enhance anti-tumor immunity

Abstract We strive to improve the outcomes of cancer immunotherapy by using a new generation of chemically modified self-delivering antisense oligonucleotides (ASO), termed FANA ASO, to target the key T-regulatory (Treg) cell transcription factor, FOXP3. We tested five murine FANA in 2 murine tumor models (TC1, MC38) and studied 19 human FANA FOXP3 in vitro with human healthy donor PBMC, followed by use of clinical samples from lung cancer patients and patients with mesothelioma, as well as testing in humanized mice (hu-PBMC-NSG). In murine studies, we treated mice on day 7 after tumor inoculation with Scramble control or murine FANA FOXP3, 50 mg/kg for 14 days, i.p. In the TC1 lung tumor model, we found an average 38% decrease of tumor volumes, p = 0.0007, and 22% of tumors were completely resorbed. In the MC38 colon carcinoma model, we found a 49% decrease of tumor volumes, p = 0.0182, and 13.6% of tumors were completely resorbed. In both tumor models, we observed an ~50% decrease of Foxp3 mRNA by qPCR, and decreased numbers of intratumoral Tregs by flow cytometry. This was accompanied by significant decreases (p&amp;lt;0.05) of the mRNA and protein intratumoral levels of multiple exhaustion markers: LAG-3, CTLA-4, PD-1, Tim-3, Tigit, CD244, CD160 and VISTA, and increased expression of perforin and granzyme-b by intratumoral T cells. In addition, there were no changes in FOXP3 mRNA expression or in the numbers of Tregs in draining lymph nodes and in spleens of tumor bearing mice, suggesting that intratumoral Treg have enhanced sensitivity to FANA FOXP3 in vivo. We identified the best 5 of 19 human FANA FOXP3 and showed these had no toxic effects on cell viability or division, and downregulated FOXP3 expression over 50% in PBMC from healthy donors (p&amp;lt;0.05). Human Treg, pre-incubated with FANA FOXP3 for 3 hours, retained only 60.3% of their suppressive function in vitro. FANA FOXP3 treatment of lung cancer tumor samples and mesothelioma pleural effusion samples resulted in a 56.4% decrease in FOXP3 mRNA expression and a 61.5% decrease in Treg numbers (all p&amp;lt;0.05). Moreover, tumor FOXP3+ Treg had 36.7% less FOXP3 protein per cell, and downregulated CD39 expression compared to Scramble control. Targeting of cancer samples with human FANA FOXP3 in vitro was associated with increased division of CD4+ and CD8+ cells, and with downregulation of multiple exhaustion molecules, including CTLA-4, Tim-3, PD-1, LAG-3 and TIGIT. Humanized mice, treated with two human FANA FOXP3 compounds (50 mg/kg, 7days), demonstrated an absence of apparent toxic effects and human FOXP3 mRNA was downregulated by 47.4% in the blood, by 74.2% in lymph nodes and by 51.8% in the spleens (all p&amp;lt;0.05). Hence, targeting of intratumoral Tregs using FANA FOXP3 results in enhanced immune responses to solid tumors without inducing autoimmunity, and studies are underway in combination with checkpoint inhibitors and/or CAR-T cell therapy. Citation Format: Tatiana Akimova, Liqing Wang, Zhanna Bartosh, Evgeniy Eruslanov, Steven Albelda, Sunil Singhal, Veenu Aishwarya, Wayne W. Hancock. Targeting CD4+FOXP3+ Tregs to enhance anti-tumor immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3255.

Abstract 6523: TOX upregulation promotes a GPX4-dependent CD8+ T cell ferroptosis in tumor microenvironments

Abstract Frequency and function of CD8+ tumor-infiltrating T cells (TILs) decide on clinical outcome of cancer immunotherapy; and TOX function as a crucial regulator of TIL dysfunction. In the present study, we found that multiplex factors, such as tumor cell, viral antigens and hypoxia, in tumor microenvironments (TME) induced CD8+ TIL ferroptosis by upregulating TOX. Single cell RNA-sequencing revealed that TOX modulated Havcr2, Pdcd1, Hmox1, Gpx4, and Ctsb transcription in human and murine CD8+ TILs. We further generated TOX conditional knockout in CD8+ T cell (Toxflox/floxCd8Cre, CKO) mice and the tumor-bearing CKO mice exhibited increased anti-tumor immunity and survival time. TOX upregulation increased reactive oxygen species (ROS), lipid peroxidation, and ferrous iron, leading to a GPX4-dependent CD8+ T cell ferroptosis. Genetic or antibody ablation of TOX, TIM-3, or HO-1 indicated that these molecules orchestrated CD8+ TIL ferroptosis by inducing iron overload and lipid peroxidation. Targeting TOX, PD-1, TIM-3, or ferroptosis boosted the anti-tumor suppression of tumor-specific T cell-based adoptive cell therapy (ACT) in murine tumor model. TOX, TIM-3 and GPX4 were prognostic predictors in human cervical cancer. This finding identifies a novel mechanism of tumor-induced CD8+ T cell ferroptosis underwent by TOX that provides new insights in improving TIL-based ACT immunotherapy. Key words: TOX, CD8+ T cells, ferroptosis, tumor microenvironments, cancer immunotherapy Citation Format: Jiang Li, Qian Zhu, Xiufeng Liu. TOX upregulation promotes a GPX4-dependent CD8+ T cell ferroptosis in tumor microenvironments [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6523.