Background Breast cancer (BrC) is the most prevalent cancer in women worldwide. Unfortunately, still limited treatment options are available for the most aggressive subtypes (i.e. hormone receptor [HR] negative). The response to neoadjuvant chemotherapy (NACT) in patients with HR-negative BrC can in part be influenced by an effective anti-tumor immune response. The sentinel lymph node (SLN) is the first site where BrC-specific T cell priming will occur but unfortunately it is also a major target of BrC-induced immune suppression. Lymph-node resident dendritic cells (LNR-DC) were found to be suppressed in metastatic SLN.1 In addition, this tumor-mediated immune suppression of LNR-DC is related to high-risk triple-negative BrC and may be a negative predictor for prognosis1. Preliminary data showed that NACT further reduced the activation status of LNR-DC. The goal of this study is to identify immune-enhancing agents that can counteract the tumor-mediated immune suppression of LNR-DC and promote tumor-specific T cell responses in order to improve therapy outcome in BrC patients upon NACT.
Materials and Methods Phenotypic analyses were performed on immune-cell subsets in human BrC SLN using multi-color flow cytometry. In addition, ex-vivo cultures with human BrC SLN-derived cells and in vivo mouse experiments were performed to study the therapeutic efficacy of Toll-like receptor (TLR)-ligands (R848 and CpG) and a STING-ligand (STING-L; 2’3’-c-di-AM(PS)2(Rp,Rp)).
Results Higher rates of LNR-DCs, but with an apparently reduced activation state, were found in SLN of NACT-treated patients compared to patients treated with surgery only. A comparative ex-vivo study with SLN cultures on the effects of R848, CpG-B and STING-L showed R848 to be superior in terms of LNR-DC activation. In a Krt14 (K14)-cre;Cdh1F/F;Trp53F/F (KEP) BrC mouse model, the effects of intratumoral administration of TLR- and STING-L were determined in combination with doxorubicin. STING-L outperformed R848 and CpG-B in terms of controlling primary tumor growth. Of note, in human ex-vivo cultures CpG-B proved effective in LNR-DC activation when combined with a STAT3 inhibitor, leading to the boosting of mammaglobin-specific T cell responses, Th1 skewing, and a drop in CpG-induced Treg levels.
Conclusions In summary, intratumoral delivery of TLR- and STING-ligands in combination with NACT might be an interesting therapeutic approach in patients with high-risk HR-negative BrC, leading to SLN potentiation and enhanced antitumor T cell immunity. Future clinical studies should demonstrate the therapeutic benefit of this approach.
van Pul, et al. 2019, Journal for ImmunoTherapy of Cancer.
Disclosure Information N. Prokopi: None. M. Heeren: None. I. Milenova: None. K. van Pul: None. T. Muijlwijk: None. M. Arends: None. S. van der Velde: None. K. Vrijland: None. A. van Weverwijk: None. K. de Visser: None. R. van de Ven: None. T. de Gruijl: None.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.