In a comprehensive study with several mouse tumor models (EMT-6, s.c and i.v. B16-F10, MC38, and CT26), Lewis et al. explored the addition of IL-21 to either anti-PD-1 or anti-CTLA-4. IL-21 enhanced the antitumor efficacy of anti-CTLA-4 in four models, and of anti-PD-1 in two models (MC38 and B16-F10). Both combinations reduced the number of surface lung metastases in the i.v. model. Phenotypic analysis of TILs indicated that IL-21 decreased intratumoral Tregs, enhanced CD8+ effector response, and reduced T cell exhaustion.

Recent advances in cancer treatment with checkpoint blockade of receptors such as CTLA-4 and PD-1 have demonstrated that combinations of agents with complementary immunomodulatory effects have the potential to enhance antitumor activity as compared to single agents. We investigated the efficacy of immune-modulatory interleukin-21 (IL-21) combined with checkpoint blockade in several syngeneic mouse tumor models. After tumor establishment, mice were administered recombinant mouse IL-21 (mIL-21) alone or in combination with blocking monoclonal antibodies against mouse PD-1 or CTLA-4. In contrast to monotherapy, IL-21 enhanced antitumor activity of mCTLA-4 mAb in four models and anti-PD-1 mAb in two models, with evidence of synergy for one or both of the combination treatments in the EMT-6 and MC38 models. The enhanced efficacy was associated with increased intratumoral CD8+ T cell infiltrates, CD8+ T cell proliferation, and increased effector memory T cells, along with decreased frequency of central memory CD8+ T cells. In vivo depletion of CD8+ T cells abolished the antitumor activities observed for both combination and monotherapy treatments, further supporting a beneficial role for CD8+ T cells. In all studies, the combination therapies were well tolerated. These results support the hypothesis that the combination of recombinant human IL-21 with CTLA-4 or PD-1 monoclonal antibodies could lead to improved outcomes in cancer patients.

Author Info: (1) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (2) Oncology Discovery Research, Bristol-Myers Squibb, Redwood City, CA. (3) Oncology Translational Research, Br

Author Info: (1) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (2) Oncology Discovery Research, Bristol-Myers Squibb, Redwood City, CA. (3) Oncology Translational Research, Bristol-Myers Squibb, Princeton, NJ. (4) Oncology Discovery Research, Bristol-Myers Squibb, Redwood City, CA. (5) Oncology Translational Research, Bristol-Myers Squibb, Princeton, NJ. (6) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (7) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (8) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (9) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA. (10) Drug Safety Evaluation, Bristol-Myers Squibb, Mt. Vernon, IN. (11) Early Clinical Development, Bristol-Myers Squibb, Princeton, NJ. (12) Oncology Discovery Research, Bristol-Myers Squibb, Redwood City, CA. (13) Oncology Translational Research, Bristol-Myers Squibb, Princeton, NJ. (14) Oncology Discovery Research, Bristol-Myers Squibb, Seattle, WA.