Willingham et al. established CPI-444 as a potent and selective small molecule inhibitor of the immunosuppressive adenosine receptor A2AR. In vitro, CPI-444 restored human T cell signaling, activation, and Th1 cytokine (IL-2 and IFNγ) release in the presence of inhibitory adenosine analogs. In mouse tumor models, CPI-444 reduced tumor growth, mediating complete and durable regression in some animals. Combinations with anti-PD-1 or anti-CTLA-4 showed enhanced antitumor efficacy. Treatment with CPI-444 also increased tumor expression of CD73 (plays a role in adenosine production), which may indicate a mechanism of tumor immune escape.
Adenosine signaling through A2A receptors (A2AR) expressed on immune cells suppresses antitumor immunity. CPI-444 is a potent, selective, oral A2AR antagonist. Blockade of A2AR with CPI-444 restored T-cell signaling, IL2, and IFNgamma production that were suppressed by adenosine analogs in vitro. CPI-444 treatment led to dose-dependent inhibition of tumor growth in multiple syngeneic mouse tumor models. Concentrations of extracellular adenosine in the tumor microenvironment, measured using microdialysis, were approximately 100 -150 nM and were higher than corresponding subcutaneous tissue. Combining CPI-444 with anti-PD-L1 or anti-CTLA-4 treatment eliminated tumors in up to 90% of treated mice, including restoration of immune responses in models that incompletely responded to anti-PD-L1 or anti-CTLA-4 monotherapy. Tumor growth was fully inhibited when mice with cleared tumors were later re-challenged, indicating that CPI-444 induced systemic antitumor immune memory. CD8+ T-cell depletion abrogated the efficacy of CPI-444 with and without anti-PD-L1 treatment, demonstrating a role for CD8+ T cells in mediating primary and secondary immune responses. The antitumor efficacy of CPI-444 with and without anti-PD-L1 was associated with increased T-cell activation, a compensatory increase in CD73 expression, and induction of a Th1 gene expression signature consistent with immune activation. These results suggest a broad role for adenosine-mediated immunosuppression in tumors and justify the further evaluation of CPI-444 as a therapeutic agent in patients with solid tumors.