Enhancing the Generation of Eomeshi CD8+ T Cells Augments the Efficacy of OX40- and CTLA-4-Targeted Immunotherapy

CTLA-4 blockade in combination with an agonist OX40-specific monoclonal antibody synergizes to augment antitumor immunity through enhanced T-cell effector function, leading to increased survival in preclinical cancer models. We have shown previously that anti-OX40/anti-CTLA-4 combination therapy synergistically enhances the expression of Eomesodermin (Eomes) in CD8⁺ T cells. Eomes is a critical transcription factor for the differentiation and memory function of CD8⁺ T cells. We hypothesized that Eomes^hiCD8⁺ T cells were necessary for anti-OX40/anti-CTLA-4 immunotherapy efficacy and that further enhancement of this population would improve tumor-free survival. Indeed, CD8⁺ T cell-specific deletion of Eomes abrogated the efficacy of anti-OX40/anti-CTLA-4 therapy. We also found that anti-OX40/anti-CTLA-4-induced Eomes^hiCD8⁺ T cells expressed lower levels of checkpoint receptors (PD1, Tim-3, and Lag-3) and higher levels of effector cytokines (IFNγ and TNFα) than their Eomes^lo counterparts. Eomes expression is negatively regulated in T cells through interleukin-2-inducible T-cell kinase (ITK) signaling. We investigated the impact of modulating ITK signaling with ibrutinib, an FDA-approved tyrosine kinase inhibitor, and found that anti-OX40/anti-CTLA-4/ibrutinib therapy further enhanced CD8⁺ T cell-specific Eomes expression, leading to enhanced tumor regression and improved survival, both of which were associated with increased T-cell effector function across multiple tumor models. Taken together, these data demonstrate the potential of anti-OX40/anti-CTLA-4/ibrutinib as a triple therapy to improve the efficacy of immunotherapy.

Efficacy of agonist αOX40 and antagonist αCTLA-4 cancer immunotherapy is increased by ibrutinib treatment through enhanced Eomes expression and T-cell response

Antagonistic monoclonal antibodies targeting individual checkpoint receptors on T cells, such as CTLA-4 and PD-1, are used to treat patients with metastatic disease; however, only a subset of patients respond. Combination therapies, such as CTLA-4 blockade with agonist αOX40 mAb, are synergistic in preclinical models. αOX40/αCTLA-4 therapy synergistically enhances expression of Eomesodermin (Eomes), a transcription factor that drives CD8 T cell differentiation and memory function. We hypothesize that Eomes expression plays a critical role in the synergistic efficacy of αOX40/αCTLA-4 therapy. Compared to Eomeslo CD8 T cells, Eomeshi CD8 T cells induced by αOX40/αCTLA-4 therapy express lower levels of checkpoint receptors (PD-1, TIM-3, LAG-3) and higher levels of tumor trafficking and activation markers (CXCR3, CD44), and intratumoral cytokines (IFN-γ, TNF-α). CD8 T cell-specific Eomes−/− tumor-bearing mice did not respond to αOX40/αCTLA-4 therapy, demonstrating the necessity of Eomes expressing CD8 T cells. Interleukin-2 inducible T cell kinase (ITK) negatively regulates T cell Eomes expression following T cell receptor ligation. Thus, we asked whether enhancing T cell Eomes expression by combining ibrutinib, an FDA-approved ITK inhibitor, with αOX40/αCTLA4 therapy would further improve anti-tumor responses by increasing Eomeshi CD8 T cells. This triple combination increased CD8 T cell-specific Eomes expression, tumor-specific CD8 T cells, Ki-67 (proliferation), and Th1 cytokines (IFN-γ, TNF-α) leading to reduced tumor growth and improved survival over αOX40/αCTLA-4 alone, making ibrutinib/αOX40/αCTLA-4 a potential novel triple combination therapy.

Immunological Complexity of the Prostate Cancer Microenvironment Influences the Response to Immunotherapy

Prostate cancer is one of the most common cancers in men and a leading cause of cancer-related death. Recent advances in the treatment of advanced prostate cancer, including the use of more potent and selective inhibitors of the androgen signaling pathway, have provided significant clinical benefit for men with metastatic castration-resistant prostate cancer (mCRPC). However, most patients develop progressive lethal disease, highlighting the need for more effective treatments. One such approach is immunotherapy, which harness the power of the patient's immune system to identify and destroy cancer cells through the activation of cytotoxic CD8 T cells specific for tumor antigens. Although immunotherapy, particularly checkpoint blockade, can induce significant clinical responses in patients with solid tumors or hematological malignancies, minimal efficacy has been observed in men with mCRPC. In the current review, we discuss our current understanding of the immunological complexity of the immunosuppressive prostate cancer microenvironment, preclinical models of prostate cancer, and recent advances in immunotherapy clinical trials to improve outcomes for men with mCRPC.

Overcoming Tumor-Induced Immune Suppression: From Relieving Inhibition to Providing Costimulation with T Cell Agonists

Recent advancements in T-cell biology and antibody engineering have opened doors to significant improvements in cancer immunotherapy. Initial success with monoclonal antibodies targeting key receptors that inhibit T-cell function such as cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed death-ligand 1 (PD-1) have demonstrated the potency of this new class of therapy, highlighted by long-term complete responses for metastatic cancers once thought incurable. However, only a subset of patients responds to checkpoint blockade because of a multitude of factors, including an immunosuppressive tumor microenvironment and the mutational burden of the cancer. Novel antibodies, as well as ligand-immunoglobulin fusion proteins that target costimulatory immune receptors, are being developed and tested in clinical trials to further enhance the anti-tumor immune response. Many of these costimulatory receptors are in the tumor necrosis factor receptor superfamily (TNFRSF) and are expressed on multiple immune cell types, including inhibitory cells. While TNFRSFs signal through common pathways, the outcome of targeting different receptors depends on the functional status of the cell types expressing the relevant receptors. In this review, we discuss the current state of targeted costimulatory immunotherapy.

Integrin alpha 5 beta 1 expression negatively regulates cell growth: reversal by attachment to fibronectin

Cells selected for overexpression of the integrin alpha 5 beta 1 show decreased proliferation and loss of the transformed phenotype. We provide evidence that de novo expression of the integrin alpha 5 beta 1 in HT29 colon carcinoma cells results in the growth arrest of these cells as characterized by reduced DNA synthesis and cellular proliferation in vitro. In fact, expression of integrin alpha 5 beta 1 on these cells induces the transcription of growth arrest specific gene 1 (gas-1), a gene product known to induce cellular quiescence, but blocks transcription of the immediate early genes c-fos, c-jun, and jun B. In vivo, the alpha 5 beta 1 transfectants display dramatically reduced tumorigenicity as well as a highly differentiated phenotype when compared with their pSVneo-transfected counterparts. Surprisingly, ligation of alpha 5 beta 1 on these cells by cell attachment to a fibronectin substrate not only reverses the growth inhibition and gas-1 gene induction but activates immediate early gene transcription. These findings demonstrate that integrin alpha 5 beta 1 expression in the absence of attachment to fibronectin activates a signaling pathway leading to decreased cellular proliferation and that ligation of this receptor with fibronectin reverses this signal, thereby contributing to the proliferation of transformed cells.