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Heine A, Flores C, Gevensleben H, Diehl L, Heikenwalder M, Ringelhan M, Janssen KP, Nitsche U, Garbi N, Brossart P, Knolle PA, Kurts C, Höchst B. Targeting myeloid derived suppressor cells with all-trans retinoic acid is highly time-dependent in therapeutic tumor vaccination. Oncoimmunology 2017; 6:e1338995. [PMID: 28920004 DOI: 10.1080/2162402x.2017.1338995] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/28/2017] [Accepted: 06/01/2017] [Indexed: 12/30/2022] Open
Abstract
Tumor immune escape is a critical problem which frequently accounts for the failure of therapeutic tumor vaccines. Among the most potent suppressors of tumor immunity are myeloid derived suppressor cells (MDSCs). MDSCs can be targeted by all-trans-retinoic-acid (atRA), which reduced their numbers and increased response rates in several vaccination studies. However, not much is known about the optimal administration interval between atRA and the vaccine as well as about its mode of action. Here we demonstrate in 2 different murine tumor models that mice unresponsive to a therapeutic vaccine harbored higher MDSC numbers than did responders. Application of atRA overcame MDSC-mediated immunosuppression and restored tumor control. Importantly, atRA was protective only when administered 3 d after vaccination (delayed treatment), whereas simultaneous administration even decreased the anti-tumor immune response and reduced survival. When analyzing the underlying mechanisms, we found that delayed, but not simultaneous atRA treatment with vaccination abrogated the suppressive capacity in monocytic MDSCs and instead caused them to upregulate MHC-class-II. Consistently, MDSCs from patients with colorectal carcinoma also failed to upregulate HLA-DR after ex vivo treatment with TLR-ligation. Overall, we demonstrate that atRA can convert non-responders to responders to vaccination by suppressing MDSCs function and not only by reducing their number. Moreover, we identify a novel, strictly time-dependent mode of action of atRA to be considered during immunotherapeutic protocols in the future.
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Affiliation(s)
- Annkristin Heine
- Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn, Germany.,Institute of Experimental Immunology, University Bonn, Germany
| | - Chrystel Flores
- Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn, Germany.,Institute of Experimental Immunology, University Bonn, Germany
| | | | - Linda Diehl
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Germany.,Institute of Molecular Medicine, University Bonn, Germany
| | - Mathias Heikenwalder
- Institute of Virology, Technische Universität München.,Division of Chronic Inflammation and Cancer, German Cancer Research Center, DKFZ, Germany
| | - Marc Ringelhan
- Department for Internal Medicine 2, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | - Ulrich Nitsche
- Department of Surgery, Technische Universität München, Germany
| | - Natalio Garbi
- Institute of Experimental Immunology, University Bonn, Germany
| | - Peter Brossart
- Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn, Germany
| | - Percy A Knolle
- Institute of Molecular Medicine, University Bonn, Germany.,Institute of Molecular Immunology and Experimental Oncology, Technische Universität München, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Bonn, Germany
| | - Bastian Höchst
- Institute of Molecular Medicine, University Bonn, Germany.,Institute of Molecular Immunology and Experimental Oncology, Technische Universität München, Germany
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2
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Wu CF, Wang HM, Huang WK, Chang JWC. Efficacy and safety of bio-chemotherapy with dacarbazine plus interleukin-2 in patients with unresectable malignant melanoma. Asia Pac J Clin Oncol 2015; 11:314-8. [DOI: 10.1111/ajco.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Chun-Feng Wu
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Wen-Kuan Huang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
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3
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Abstract
The last 30 years has seen a revolution in melanoma. Fundamental elements of the surgical, adjuvant medical, and systemic therapy for the disease have been significantly altered toward improved management and better outcomes. The intent of this article is to reflect on past efforts and research in melanoma and the current landscape of treatment of melanoma. The authors also hope to capture the excitement currently rippling through the field and the hope for a cure. The intent of treatment of advanced melanoma, which was once considered incurable, has changed from palliative to potentially curative.
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Affiliation(s)
- Vikram C Gorantla
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - John M Kirkwood
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, 5150 Centre Avenue, Pittsburgh, PA 15232, USA; Melanoma and Skin Cancer Program, University of Pittsburgh Cancer Institute, 5115 Centre Avenue, Suite 1.32, Pittsburgh, PA 15232, USA.
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4
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Jilaveanu LB, Aziz SA, Kluger HM. Chemotherapy and biologic therapies for melanoma: do they work? Clin Dermatol 2009; 27:614-25. [DOI: 10.1016/j.clindermatol.2008.09.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anderson CM, Buzaid AC, Grimm EA. Interaction of chemotherapy and biological response modifiers in the treatment of melanoma. Cancer Treat Res 1996; 87:357-80. [PMID: 8886461 DOI: 10.1007/978-1-4613-1267-3_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C M Anderson
- Department of Medical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Dummer R, Gore ME, Hancock BW, Guillou PJ, Grobben HC, Becker JC, Oskam R, Dieleman JP, Burg G. A multicenter phase II clinical trial using dacarbazine and continuous infusion interleukin-2 for metastatic melanoma. Clinical data and immunomonitoring. Cancer 1995; 75:1038-44. [PMID: 7842406 DOI: 10.1002/1097-0142(19950215)75:4<1038::aid-cncr2820750421>3.0.co;2-f] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Treatment of patients with metastatic melanoma with either dacarbazine or recombinant interleukin-2 (rIL-2) resulted in a response rate of approximately 15%. This study investigates the possible synergism of this chemoimmunotherapy combination. METHODS Fifty-seven patients with metastatic malignant melanoma received 135 treatment cycles. Treatment consisted of dacarbazine (Days 1-5) at 250 mg/m2 by a 30-minute slow infusion, and interleukin-2 by constant intravenous infusion (Days 21-25 and 28-32) at 18 x 10(6) IU/m2/24 hours. After this treatment cycle, a 1-week rest was scheduled, and in the absence of undue toxicity or tumor progression, patients received a second cycle as described. Maximum treatment consisted of two induction and four maintenance cycles. In a subgroup of patients, immunoparameters were analyzed to identify prognostic factors. Standard supportive care was given. RESULTS Common toxicities included fever, hypotension, nausea/vomiting, anemia, leukopenia, thrombocytopenia, an increase in serum lactic dehydrogenase levels and diarrhea. The objective response rate was 15.8% (one complete response and eight partial responses). In 14 patients, the disease stabilized. For patients who had an objective response, median response duration was 13.9 months (6.3-39.0+), and median survival was 19.0 months (6.3-39.0+); overall survival was 9.3 months (0.8-39.0+). Immunomonitoring did not reveal any relevant prognostic factors for overall response. CONCLUSIONS Sequential treatment with dacarbazine and rIL-2 is feasible and produces long-lasting responses in a minority of patients.
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Affiliation(s)
- R Dummer
- Department of Dermatology, University of Zurich Medical School, Switzerland
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7
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Courtney LP, Phelps JL, Karavodin LM. An anti-IL-2 antibody increases serum half-life and improves anti-tumor efficacy of human recombinant interleukin-2. IMMUNOPHARMACOLOGY 1994; 28:223-32. [PMID: 7852053 DOI: 10.1016/0162-3109(94)90058-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We examined the ability of anti-human recombinant interleukin-2 (hu rIL-2) monoclonal antibody DMS-1.10 to increase serum half-life of hu rIL-2, and the effect of this complex on inhibition of tumor progression in a B16-F10 murine melanoma model. In C57B1/6 mice, intravenous (i.v.) injection of DMS-1.10 premixed with 1 x 10(4) units (U) of hu rIL-2 at a 1:1 molar ratio extended serum half-life greater than 10-fold (222 min) when compared to the same dose of hu rIL-2 alone (20 min). In a murine tumor model, multiple intraperitoneal (i.p.) injections of non-neutralizing DMS-1.10 premixed with hu rIL-2 at a 5:1 molar ratio reduced the growth rate of subcutaneous (s.c.) B16-F10 tumor in C57B1/6 mice by 64% when compared to PBS and irrelevant antibody treated controls. Although similar treatment with hu rIL-2 alone reduced tumor growth rate by 46%, it was significantly less effective than the premixed treatment. Results from a flow cytometry assay confirm B16-F10 does not have IL-2 receptors, precluding direct inhibition of tumor growth by hu rIL-2 treatments. We propose that therapeutic efficacy of hu rIL-2 is improved by prolonging the in vivo half-life with an anti-IL-2 antibody, thus augmenting hu rIL-2 bioactivity and enhancing the hosts immune response against tumor.
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Affiliation(s)
- L P Courtney
- Hybritech Incorporated, San Diego, CA 92196-9006
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Lopez M, Carpano S, Cavaliere R, Di Lauro L, Ameglio F, Vitelli G, Frasca AM, Vici P, Pignatti F, Rosselli M. Biochemotherapy with thymosin alpha 1, interleukin-2 and dacarbazine in patients with metastatic melanoma: clinical and immunological effects. Ann Oncol 1994; 5:741-6. [PMID: 7826907 DOI: 10.1093/oxfordjournals.annonc.a058979] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND DTIC and interleukin-2 (IL-2), as single agents, have a limited anti-tumor activity in patients with metastatic melanoma. Experimentally, thymosin alpha 1 (TA1) may modulate the action of IL-2. We investigated the clinical and immunological effects of a combination with these three agents. PATIENTS AND METHODS Forty-six patients with measurable metastatic melanoma were treated with DTIC 850 mg IV on day 1, TA1 2 mg s.c. on days 4 to 7, and IL-2 18 MU/m2/d by continuous intravenous infusion on days 8 to 12. Cycles were repeated every 3 weeks. RESULTS Objective responses were obtained in 15 (36%) of 42 evaluable patients (CI at 95%: 22%-50%). Two patients experienced complete responses, and stable disease was observed in five. The median time to progression was 5.5 months and median survival was 11 months. Side effects were predominantly caused by IL-2. Treatment was tolerated reasonably well, and there was no overlapping toxicity or interference between chemotherapy and biotherapy. Baseline sCD4 levels seem to correlate to tumor burden. Patients benefiting from treatment had lower sCD4 and higher sCD8 than did progressing patients. CONCLUSIONS The combination of DTIC + TA1 + IL-2 is active in the treatment of advanced melanoma, with acceptable toxicity. However, even more active regimens are needed, and the interactions between thymic hormones and cytokines should be further explored.
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Affiliation(s)
- M Lopez
- Regina Elena Institute for Cancer Research, Rome, Italy
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Affiliation(s)
- L T Vlasveld
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam
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10
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Gazit Z, Kedar E. Chemotherapy-induced modulation of natural killer and lymphokine-activated killer cell activity in euthymic and athymic mice. Cancer Immunol Immunother 1994; 38:243-52. [PMID: 8168119 PMCID: PMC11038819 DOI: 10.1007/bf01533515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/1993] [Accepted: 11/30/1993] [Indexed: 01/29/2023]
Abstract
Combinations of chemotherapy and interleukin-2 (IL-2) aimed at improving therapeutic efficacy in cancer patients have generally proved disappointing. Although chemotherapy blocks tumor growth and sometimes boosts immune functions, most drugs are immunosuppressive, at least transiently. Therefore, it is reasonable to assume that maximal exploitation of the immunostimulatory and antitumor activity of both modalities requires careful coordination of chemotherapy and IL-2 timing. We analyzed the temporal effect of 5-fluorouracil (5-FU, 100-120 mg/kg), cyclophosphamide (CY, 100 mg/kg), Adriamycin (8 mg/kg) and dacarbazine (100 mg/kg) on the activation of natural killer/lymphokine-activated killer (NK/LAK) cells by IL-2 in several strains of euthymic mice and in athymic nude mice. Following in vivo or in vitro exposure to IL-2 1-15 days after chemotherapy, the total lytic activity of the spleen and the number of LAK precursors (LAK-p) were measured. In euthymic mice injected with IL-2 (5 x 10(4) Cetus units twice daily for 4-5 days), 5-FU augmented (up to 37-fold, days 1-9) and CY reduced (up to day 6) LAK activity, as compared with that in the IL-2 control. In bulk cultures containing IL-2 (1000 CU/ml, 3-4 days), both 5-FU and CY reduced LAK activity of euthymic mice splenocytes for up to 6 days after chemotherapy, which was followed on day 9 by full recovery. In splenocytes of nude mice, 5-FU increased and CY diminished LAK activation in bulk cultures, starting 3 days after chemotherapy. In athymic mice, 5-FU markedly augmented the total number of LAK-p/spleen (up to 30-fold, days 3-9), as determined by limiting-dilution cultures with IL-2 (for 7-8 days). In euthymic mice, in contrast, LAK-p levels decreased for up to 6-9 days after treatment with 5-FU, Adriamycin or decarbazine, later recovering to pretreatment levels, whereas CY markedly increased LAK-p (up to 15-fold) when administered 6-12 days before limiting-dilution culture initiation. The effect of chemotherapy on LAK and NK activity was essentially similar. In other experiments, a subset of asialoGM1- LAK-p was found in the spleens of 5-FU-treated mice, but not in untreated mice. Our results suggest that the immunomodulatory effect of chemotherapy on NK/LAK activity in mice is variable and largely depends on the drug itself, the interval between chemotherapy and IL-2 administration, the strain of mice and the assay used.
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Affiliation(s)
- Z Gazit
- Lautenberg Center for General and Tumor Immunology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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11
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Gazit Z, Weiss DW, Shouval D, Yechezkeli M, Schirrmacher V, Notter M, Walter J, Kedar E. Chemo-adoptive immunotherapy of nude mice implanted with human colorectal carcinoma and melanoma cell lines. Cancer Immunol Immunother 1992; 35:135-44. [PMID: 1596937 PMCID: PMC11038707 DOI: 10.1007/bf01741861] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/1991] [Accepted: 02/04/1992] [Indexed: 12/27/2022]
Abstract
The antitumor effects of chemotherapy, recombinant human interleukin-2 (IL-2), recombinant human interferon alpha A/D (IFN alpha), allogeneic human lymphokine-activated killer (LAK) cells, and antitumor monoclonal antibody (mAb), administered alone and in various combinations, were tested in athymic nude mice carrying human tumor xenografts. Treatment began 6-18 days after i.v. or i.p. inoculation of colorectal carcinoma or melanoma cell lines, when macroscopic growths were evident. Chemotherapy consisted of two or three courses of 5-fluorouracil (5-FU) or dacarbazine. IL-2 and/or IFN alpha were administered three to five times weekly for 1-3 weeks, usually starting 2-5 days after chemotherapy. Human LAK cells were infused once or twice weekly for 2 or 3 weeks concurrently with IL-2. In some experiments, murine anticolorectal carcinoma mAb (SF25) was administered. In both tumor systems, chemotherapy alone or immunotherapy alone (IL-2, IL-2 + LAK cells, IFN alpha, IL-2 + IFN alpha +/- LAK cells) had little or no therapeutic effects. Additive effects were obtained by combining chemotherapy with IL-2 and LAK cells or with IL-2 and IFN alpha. In the majority of the experiments, the most effective combination was chemotherapy + IL-2 + IFN alpha + LAK cells. Treatment with mAb was beneficial in the colorectal carcinoma system when combined with 5-FU + IL-2 or 5-FU + IL-2 + IFN alpha. Homing experiments with radiolabeled human and mouse LAK cells injected i.v. showed increased early accumulation in the liver and lungs, whereas freshly explanted mouse splenocytes localized mostly in the spleen and liver. The tissue distribution pattern of human LAK cells was similar in normal and tumor-bearing mice (with lung metastases). These findings suggest that combination of chemotherapy with cytokines and LAK cells can be partially effective for advanced solid human tumors even in the absence of the host's T-cell immune response. Preliminary experiments showed that tumor-specific, anti-melanoma T-cell clones were effective in local (s.c.) tumor growth inhibition (Winn assay) following coinjection with the autologous tumor cells.
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Affiliation(s)
- Z Gazit
- Lautenberg Center for General and Tumor Immunology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Kedar E, Rutkowski Y, Leshem B. Chemo-immunotherapy of murine solid tumors: enhanced therapeutic effects by interleukin-2 combined with interferon alpha and the role of specific T cells. Cancer Immunol Immunother 1992; 35:63-8. [PMID: 1611625 PMCID: PMC11038410 DOI: 10.1007/bf01741057] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/1991] [Accepted: 12/10/1991] [Indexed: 12/27/2022]
Abstract
The aim of the present study has been to assess the therapeutic efficacy of various cytokines, singly or in combination, with and without chemotherapy (cyclophosphamide, Cy), in mice carrying advanced, weakly immunogenic tumors (MCA-105 sarcoma, M109 carcinoma). Treatment of animals with i.p. growths or experimental pulmonary metastases began 8-18 days after i.p. or i.v. tumor cell inoculation respectively. None of the cytokines tested [interleukin-2 (IL-2), interferon alpha (IFN alpha), tumor necrosis factor alpha (TNF alpha) and macrophage-colony-stimulating factor (M-CSF)] nor Cy had by itself a significant curative effect. A synergistic therapeutic effect was obtained with IL-2 or IFN alpha (but not with TNF alpha or M-CSF) in combination with Cy. The most efficacious regimen (65%-90% cure of mice carrying i.p. tumors) was the combination of Cy+IL-2+IFN alpha. Preliminary experiments suggested that sequential administration of these cytokines might be more beneficial than concurrent administration. Following successful immunotherapy, long-term (3-6 months) survivors showed a tumor-specific resistance to a second tumor challenge and their spleen contained an increased number of specific antitumor cytotoxic T lymphocyte precursors (5- to 20-fold, compared to control mice). In vitro and in vivo cell-depletion experiments using monoclonal antibodies revealed that T cells (primarily CD8), but not NK cells, are crucial for the therapeutic effects. This study indicates that a potent specific antitumor T cell immunity can be elicited against advanced weakly immunogenic tumors by combining chemotherapy (Cy) with IL-2 and IFN alpha.
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Affiliation(s)
- E Kedar
- Lautenberg Center for General and Tumor Immunology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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