In a mouse model of PD-1-resistant melanoma, a triple combination of PD-1 blockade, CD40 agonism, and CSF1R blockade (TTx) could overcome resistance and induce durable complete responses in a majority of mice. Responses were mainly driven by the CD40 agonist within the first 24 hours, which enhanced the function of DCs with an mregDC phenotype, leading to increased secretion of CCL22, CCL5, and IL-12 and enhanced priming of antitumor CD4+ and CD8+ T cells. A novel lipid nanoparticle-based therapeutic containing IL-12 mRNA was also sufficient to overcome PD-1 resistance. Similar cytokine profiles were observed in both mice and patients treated with TTx.

Contributed by Lauren Hitchings

ABSTRACT: Checkpoint inhibitors have revolutionized cancer treatment, but resistance remains a significant clinical challenge. Myeloid cells within the tumor microenvironment can modulate checkpoint resistance by either supporting or suppressing adaptive immune responses. Using an anti-PD-1-resistant mouse melanoma model, we show that targeting the myeloid compartment via CD40 activation and CSF1R blockade in combination with anti-PD-1 results in complete tumor regression in a majority of mice. This triple therapy combination was primarily CD40 agonist-driven in the first 24 hours post-therapy and showed a similar systemic cytokine profile in human patients as was seen in mice. Functional single-cell cytokine secretion profiling of dendritic cells (DCs) using a novel microwell assay identified a CCL22+CCL5+ IL12-secreting DC subset as important early-stage effectors of triple therapy. CD4+ and CD8+ T cells are both critical effectors of treatment, and systems analysis of single-cell RNA-sequencing data supported a role for DC-secreted IL12 in priming T-cell activation and recruitment. Finally, we showed that treatment with a novel IL12 mRNA therapeutic alone was sufficient to overcome PD-1 resistance and cause tumor regression. Overall, we conclude that combining myeloid-based innate immune activation and enhancement of adaptive immunity is a viable strategy to overcome anti-PD-1 resistance.

Author Info: (1) Yale School of Medicine, New Haven, Connecticut, United States. (2) Yale University, New Haven, Connecticut, United States. (3) Yale University, New Haven, United States. (4) Y

Author Info: (1) Yale School of Medicine, New Haven, Connecticut, United States. (2) Yale University, New Haven, Connecticut, United States. (3) Yale University, New Haven, United States. (4) Yale University, New Haven, Connecticut, United States. (5) Yale University, New Haven, Connecticut, United States. (6) Yale School of Medicine, New Haven, CT, United States. (7) Yale University School of Medicine, New Haven, CT, United States. (8) Yale School of Medicine, New Haven, CT, United States. (9) AstraZeneca (United Kingdom), Cambridge, United Kingdom. (10) AstraZeneca (United Kingdom), Cambridge, United Kingdom. (11) Yale School of Medicine, New Haven, CT, United States. (12) Rutgers, The State University of New Jersey, New Brunswick, NJ, United States. (13) Yale School of Medicine, New Haven, CT, United States. (14) Salk Institute for Biological Studies, La Jolla, CA, United States. (15) Yale School of Medicine, New Haven, CT, United States. (16) Yale University, New Haven, United States. (17) Yale School of Medicine, New Haven, CT, United States.