Using tetramer staining and functional assays, Friedman et al. showed in two mouse models of multi-antigenic oral cavity carcinoma that subdominant antigen-specific tumor-infiltrating T cells express greater PD-1 and TIM3 than dominant antigen-specific T cells. Anti-PD-1 mAb treatment before or after complete surgical tumor resection reversed dysfunction of and enhanced T cell responses to subdominant and dominant tumor antigens, respectively, without altering Treg infiltration. Anti-PD-1 given before, but not after, resection enabled memory T cell generation to prevent growth of tumors lacking dominant antigens (mimicking antigen loss variants).

Contributed by Paula Hochman

PURPOSE: Surgical resection of primary tumor with regional lymphadenectomy remains the treatment of choice for patients with advanced human papillomavirus-negative head and neck squamous cell carcinoma. However, even when pathologic disease-free margins can be achieved, locoregional and/or distant disease relapse remains high. Perioperative immunotherapy may improve outcomes, but mechanistic data supporting the use of neoadjuvant or adjuvant treatment clinically is sparse. EXPERIMENTAL DESIGN: Two syngeneic models of oral cavity carcinoma with defined T cell antigens were treated with PD-1 mAb before or after surgical resection of primary tumors, and antigen-specific T cell responses were explored with functional and in vivochallenge assays. RESULTS: We demonstrated that functional immunodominance developed among T cells targeting multiple independent tumor antigens. T cells specific for subdominant antigens expressed greater levels of PD-1. Neoadjuvant, but not adjuvant, PD-1 immune checkpoint blockade broke immunodominance and induced T cell responses to dominant and subdominant antigens. Using tumors lacking the immunodominant antigen as a model of antigen escape, neoadjuvant PD-1 immune checkpoint blockade induced effector T cell immunity against tumor cells lacking immunodominant but retaining subdominant antigen. When combined with complete surgical excision, neoadjuvant PD-1 immune checkpoint blockade led to formation of immunologic memory capable of preventing engraftment of tumors lacking the immunodominant but retaining subdominant antigen. CONCLUSIONS: Together, these results implicate PD-1 expression by T cells in the mechanism of functional immunodominance among independent T cell clones within a progressing tumor, and support the use of neoadjuvant PD-1 immune checkpoint blockade in patients with surgically resectable carcinomas.

Author Info: (1) National Institute on Deafness and Other Communication Disorders, National Institutes of Health. (2) Head and Neck Surgery Branch, National Institutes of Deafness and Other Com

Author Info: (1) National Institute on Deafness and Other Communication Disorders, National Institutes of Health. (2) Head and Neck Surgery Branch, National Institutes of Deafness and Other Communication Disorders, National Institutes of Health. (3) Otolaryngology, Washington University in St. Louis. (4) Head and Neck Surgery Branch, National Institutes of Deafness and Other Communication Disorders, National Institutes of Health. (5) Head and Neck Surgery Branch, National Institutes of Deafness and Other Communication Disorders, National Institutes of Health. (6) NIDCD, National Institutes of Health. (7) NIDCD, National Institutes of Health. (8) National Institute on Deafness and Communication Disorders, National Institutes of Health. (9) Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine. (10) Johns Hopkins University School of Medicine. (11) Laboratory of Tumor Immunology & Biology, National Cancer Institute. (12) Commitee on Cancer Biology, Department of Pathology and Committee on Immunology, University of Chicago. (13) Tumor Biology Section, Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, NIH. (14) Head and Neck Surgical Oncology, Dana-Farber/Brigham and Women's Cancer Center. (15) National Institute on Deafness and Other Communication Disorders, National Institutes of Health clint.allen@nih.gov.