Robust Antitumor Responses Result from Local Chemotherapy and CTLA-4 Blockade.
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Abstract |
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Clinical responses to immunotherapy have been associated with augmentation of preexisting immune responses, manifested by heightened inflammation in the tumor microenvironment. However, many tumors have a noninflamed microenvironment, and response rates to immunotherapy in melanoma have been <50%. We approached this problem by utilizing immunotherapy (CTLA-4 blockade) combined with chemotherapy to induce local inflammation. In murine models of melanoma and prostate cancer, the combination of chemotherapy and CTLA-4 blockade induced a shift in the cellular composition of the tumor microenvironment, with infiltrating CD8 and CD4 T cells increasing the CD8/Foxp3 T-cell ratio. These changes were associated with improved survival of the mice. To translate these findings into a clinical setting, 26 patients with advanced melanoma were treated locally by isolated limb infusion with the nitrogen mustard alkylating agent melphalan followed by systemic administration of CTLA-4 blocking antibody (ipilimumab) in a phase II trial. This combination of local chemotherapy with systemic checkpoint blockade inhibitor resulted in a response rate of 85% at 3 months (62% complete and 23% partial response rate) and a 58% progression-free survival at 1 year. The clinical response was associated with increased T-cell infiltration, similar to that seen in the murine models. Together, our findings suggest that local chemotherapy combined with checkpoint blockade-based immunotherapy results in a durable response to cancer therapy. . |
Year of Publication |
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2018
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Journal |
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Cancer immunology research
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Volume |
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6
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Issue |
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2
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Number of Pages |
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189-200
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ISSN Number |
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2326-6066
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URL |
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http://cancerimmunolres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=29339377
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DOI |
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10.1158/2326-6066.CIR-17-0356
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Short Title |
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Cancer Immunol Res
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