Journal
JOURNAL OF CLINICAL INVESTIGATION
Volume 129, Issue 8, Pages 3435-3447Publisher
AMER SOC CLINICAL INVESTIGATION INC
DOI: 10.1172/JCI128562
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Funding
- NIH, NCI Cancer Center Support Grant [P30 CA008748]
- NCI [R01 CA056821]
- Ludwig Collaborative and Swim Across America Laboratory
- Emerald Foundation
- Tri-Institutional Therapeutics Discovery Institute
- Memorial Sloan Kettering Technology Development Fund, MSKCC
- Department of Medicine, MSKCC
- Weill Cornell Medicine
- NIH-T32 Postdoctoral Research Fellowship
- Parker Institute for Cancer Immunotherapy, MSKCC
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Irreversible T cell exhaustion limits the efficacy of programmed cell death 1 (PD-1) blockade. We observed that dual CD40-TLR4 stimulation within a single tumor restored PD-1 sensitivity and that this regimen triggered a systemic tumor-specific CD8(+) T cell response. This approach effectively treated established tumors in diverse syngeneic cancer models, and the systemic effect was dependent on the injected tumor, indicating that treated tumors were converted into necessary components of this therapy. Strikingly, this approach was associated with the absence of exhausted PD-1(hi) T cells in treated and distant tumors, while sparing the intervening draining lymph node and spleen. Furthermore, patients with transcription changes like those induced by this therapy experienced improved progression-free survival with anti-PD-1 treatment. Dual CD40-TLR4 activation within a single tumor is thus an approach for overcoming resistance to PD-1 blockade that is unique in its ability to cause the loss of exhausted T cells within tumors while sparing nonmalignant tissues.
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