Nayyar et al. addressed ways to improve intracranial efficacy of ICI in immunocompetent mice bearing both brain metastases and extracranial melanoma tumors. While extracranial tumors responded well to ICI, intracranial tumors did not. However, a combination of abemaciclib (a brain-penetrating CDK4/6 inhibitor) and anti-PD-1 reduced tumor burden and improved overall survival in mice. Mechanistically, the combination remodeled the TME and TCR repertoires in intracranial tumors by increasing CD8+ effector T cells, decreasing Tregs, and reducing immunosuppressive cytokines and T cell dysfunction, suggesting translational potential for treating brain metastases.

Contributed by Katherine Turner

PURPOSE: Brain metastases are associated with high morbidity and often resistant to immune checkpoint inhibitors. We evaluated whether CDK4/6 inhibitor (CDKi) abemaciclib can sensitize intracranial tumors to PD-1 inhibition in mouse models of melanoma and breast cancer brain metastasis. EXPERIMENTAL DESIGN: Treatment response was evaluated in vivo using immunocompetent mouse models of brain metastasis bearing concurrent intracranial and extracranial tumors. Treatment effect on intracranial and extracranial tumor immune microenvironments was evaluated using immunofluorescence, multiplex immunoassays, high-parameter flow cytometry and T cell receptor profiling. Mice with humanized immune systems were evaluated using flow cytometry to study the effect of CDKi on human T cell development. RESULTS: We found that combining abemaciclib with PD-1 inhibition reduced tumor burden and improved overall survival in mice. The tumor immune microenvironment, which differed based on anatomical location of tumors, was altered with CDKi and PD-1 inhibition in an organ-specific manner. Combination abemaciclib and anti-PD-1 treatment increased recruitment and expansion of CD8+ effector T cell subsets, depleted CD4+ regulatory T (TREG) cells, and reduced levels of immunosuppressive cytokines in intracranial tumors. In immunodeficient mice engrafted with human immune systems, abemaciclib treatment supported development and maintenance of CD8+ T cells and depleted TREG cells. CONCLUSIONS: Our results highlight the distinct properties of intracranial and extracranial tumors and support clinical investigation of combination CDK4/6 and PD-1 inhibition in patients with brain metastases.

Author Info: (1) Massachusetts General Hospital, Boston, MA, United States. (2) Massachusetts General Hospital, Boston, MA, United States. (3) University of Massachusetts Chan Medical School, W

Author Info: (1) Massachusetts General Hospital, Boston, MA, United States. (2) Massachusetts General Hospital, Boston, MA, United States. (3) University of Massachusetts Chan Medical School, Worcester, MA, United States. (4) Massachusetts General Hospital, Boston, United States. (5) Massachusetts General Hospital, Boston, MA, United States. (6) Massachusetts General Hospital, BOSTON, United States. (7) Massachusetts General Hospital, Boston, United States. (8) University of Massachusetts Chan Medical School, Worcester, MA, United States. (9) University of Massachusetts Chan Medical School, Worcester, MA, United States. (10) The University of Texas MD Anderson Cancer Center, Houston, United States. (11) Harvard Medical School & Massachusetts General Hospital, Boston, MA, United States. (12) University of Massachusetts Chan Medical School, Worcester, MA, United States. (13) Massachusetts General Hospital, Boston, Massachusetts, United States.