PI3Kγδ inhibitor plus radiation enhances the antitumour immune effect of PD-1 blockade in syngenic murine breast cancer and humanised patient-derived xenograft model

Introduction: We hypothesised that the combined use of radiation therapy and a phosphoinositide 3-kinase gamma delta inhibitor to reduce immune suppression would enhance the efficacy of an immune checkpoint inhibitor. Methods: Murine breast cancer cells (4T1) were grown in both immune-competent and -deficient BALB/c mice, and tumours were irradiated by 3 fractions of 24 Gy. A PD-1 blockade and a phosphoinositide 3-kinase (PI3K)gamma delta inhibitor were then administered every other day for 2 weeks. The same experiments were performed in humanised patient-derived breast cancer xenograft model and its tumour was sequenced to identify immune-related pathways and profile infiltrated immune cells. Transcriptomic and clinical data were acquired from The Cancer Genome Atlas pan-cancer cohort, and the deconvolution algorithm was used to profile immune cell repertoire. Results: Using a PI3K gamma delta inhibitor, radiation therapy (RT) and PD-1 blockade significantly delayed primary tumour growth, boosted the abscopal effect and improved animal survival. RT significantly increased CD8+cytotoxic T-cell fractions, immune-suppressive regulatory T cells (T-regs), myeloid-derived suppressor cells and M2 tumour-associated macrophages (TAMs). However, the PI3K gamma delta inhibitor significantly lowered the proportions of T-regs, myeloid-derived suppressor cells and M2 TAMs, achieving dramatic gains in splenic, nodal, and tumour CD8+ T-cell populations after triple combination therapy. In a humanised patient-derived breast cancer xenograft model, triple combination therapy significantly delayed tumour growth and decreased immune-suppressive pathways. In The Cancer Genome Atlas cohort, high T-reg/CD8+ T cell and M2/M1 TAM ratios were associated with poor overall patient survival. Conclusion: These findings indicate PI3K gamma and PI3K delta are clinically relevant targets in an immunosuppressive TME, and combining PI3K gamma delta inhibitor, RT and PD-1 blockade may overcome the therapeutic resistance of immunologically cold tumours. Synopsis: Combining PI3K gamma delta inhibitor, RT, and PD-1 blockade may be a viable clinical approach, helping to overcome the therapeutic resistance of immunologically cold tumours such as breast cancer. (C) 2021 Elsevier Ltd. All rights reserved.

Automated summary

The combination of PI3K gamma delta inhibitor, radiation therapy, and PD-1 blockade significantly delayed tumor growth, reduced immune suppression pathways, and increased the proportion of CD8+ cells.