Cubas et al. demonstrated in the MC38 murine colon cancer model (which is partially responsive to anti-PD-L1) that combination of anti-PD-L1 and chemotherapy (carboplatin, cisplatin, oxaliplatin, paclitaxel, docetaxel, gemcitabine, or cyclophosphamide) was more effective than either treatment alone. Although most chemotherapeutic agents tested had detrimental effects on T cells in the periphery and draining lymph nodes, effects on T cells in the tumor were limited, and the antitumor response was mostly dependent on TILs present at the time of treatment. Effects on immunosuppressive immune subsets were evident with some drugs.
Immunotherapy with checkpoint inhibitors has proved to be highly effective, with durable responses in a subset of patients. Given their encouraging clinical activity, checkpoint inhibitors are increasingly being tested in clinical trials in combination with chemotherapy. In many instances, there is little understanding of how chemotherapy might influence the quality of the immune response generated by checkpoint inhibitors. In this study, we evaluated the impact of chemotherapy alone or in combination with anti-PD-L1 in a responsive syngeneic tumor model. Although multiple classes of chemotherapy treatment reduced immune cell numbers and activity in peripheral tissues, chemotherapy did not antagonize but in many cases augmented the antitumor activity mediated by anti-PD-L1. This dichotomy between the detrimental effects in peripheral tissues and enhanced antitumor activity was largely explained by the reduced dependence on incoming cells for antitumor efficacy in already established tumors. The effects of the various chemotherapies were also agent specific, and synergy with anti-PD-L1 was achieved by different mechanisms that ultimately helped establish a new threshold for response. These results rationalize the combination of chemotherapy with immunotherapy and suggest that, despite the negative systemic effects of chemotherapy, effective combinations can be obtained through distinct mechanisms acting within the tumor.