Gall et al. demonstrate in vitro and in vivo that trastuzumab facilitates the FcR-mediated uptake of soluble HER2 by dendritic cells, which increases cross-presentation of the immunodominant HER2 epitope E75. This priming of adaptive immunity in trastuzumab-treated HER2+ breast cancer patients may explain the synergy between HER2-derived peptide vaccines and trastuzumab observed in ongoing clinical trials.

Early phase clinical trials evaluating CD8+ T cell-eliciting, HER2-derived peptide vaccines administered to HER2-positive breast cancer patients in the adjuvant setting suggest synergy between the vaccines and trastuzumab, the monoclonal antibody targeting the HER2 protein. Among 60 patients enrolled on clinical trials evaluating the E75+GM-CSF and GP2+GM-CSF vaccines, there have been no recurrences in patients vaccinated after receiving trastuzumab as part of standard therapy in the per treatment analyses conducted after a median follow-up of greater than 34 months. Here we describe a mechanism by which this synergy may occur. Flow cytometry showed that trastuzumab facilitated uptake of HER2 by dendritic cells (DC), which was mediated by the Fc receptor and was specific to trastuzumab. In vitro, increased HER2 uptake by DC increased cross-presentation of E75, the immunodominant epitope derived from the HER2 protein; an observation confirmed in two in vivo mouse models. This increased E75 cross-presentation, mediated by trastuzumab treatment, enabled more efficient expansion of E75-specific cytotoxic T cells (E75-CTL). These results demonstrate a mechanism by which trastuzumab links innate and adaptive immunity by facilitating activation of antigen-specific T cells. Based on these data, we conclude that HER2-positive breast cancer patients that have been treated with trastuzumab may experience a more robust antitumor immune response by restimulation of T cells with the E75 peptide vaccine, thereby accounting for the improved disease-free survival observed with combination therapy.

Author Info: (1) The University of Texas MD Anderson Cancer Center. (2) Surgical Oncology, MD Anderson Cancer Center. (3) Surgical Oncology, MD Anderson Cancer Center. (4) Stem Cell Transplanta

Author Info: (1) The University of Texas MD Anderson Cancer Center. (2) Surgical Oncology, MD Anderson Cancer Center. (3) Surgical Oncology, MD Anderson Cancer Center. (4) Stem Cell Transplantation - Research, The University of Texas M. D. Anderson Cancer Center. (5) Section of Transplantation Immunology, Department of Stem Cell Transplantation and Cellular Therapy., The University of Texas MD Anderson Cancer Center, Houston, Texas. (6) Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center. (7) The University of Texas MD Anderson Cancer Center. (8) Stem Cell Transplantation, University of Texas MD Anderson Cancer Center. (9) Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center. (10) Division of Cancer Medicine, University of Texas MD Anderson Cancer Center. (11) Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center. (12) Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center. (13) Department of Surgery, Brooke Army Medical Center. (14) Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center. (15) Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center eamitten@mdanderson.org.