A2AR antagonism with CPI-444 induces antitumor responses and augments efficacy to anti–PD-(L) 1 and anti–CTLA-4 in preclinical models

SB Willingham, PY Ho, A Hotson, C Hill… - Cancer immunology …, 2018 - AACR
SB Willingham, PY Ho, A Hotson, C Hill, EC Piccione, J Hsieh, L Liu, JJ Buggy, I McCaffery…
Cancer immunology research, 2018AACR
Adenosine signaling through A2A receptors (A2AR) expressed on immune cells suppresses
antitumor immunity. CPI-444 is a potent, selective, oral A2AR antagonist. Blockade of A2AR
with CPI-444 restored T-cell signaling, IL2, and IFNγ production that were suppressed by
adenosine analogues in vitro. CPI-444 treatment led to dose-dependent inhibition of tumor
growth in multiple syngeneic mouse tumor models. Concentrations of extracellular
adenosine in the tumor microenvironment, measured using microdialysis, were …
Abstract
Adenosine signaling through A2A receptors (A2AR) expressed on immune cells suppresses antitumor immunity. CPI-444 is a potent, selective, oral A2AR antagonist. Blockade of A2AR with CPI-444 restored T-cell signaling, IL2, and IFNγ production that were suppressed by adenosine analogues in vitro. CPI-444 treatment led to dose-dependent inhibition of tumor growth in multiple syngeneic mouse tumor models. Concentrations of extracellular adenosine in the tumor microenvironment, measured using microdialysis, were approximately 100–150 nmol/L and were higher than corresponding subcutaneous tissue. Combining CPI-444 with anti–PD-L1 or anti–CTLA-4 treatment eliminated tumors in up to 90% of treated mice, including restoration of immune responses in models that incompletely responded to anti–PD-L1 or anti–CTLA-4 monotherapy. Tumor growth was fully inhibited when mice with cleared tumors were later rechallenged, indicating that CPI-444 induced systemic antitumor immune memory. CD8+ T-cell depletion abrogated the efficacy of CPI-444 with and without anti–PD-L1 treatment, demonstrating a role for CD8+ T cells in mediating primary and secondary immune responses. The antitumor efficacy of CPI-444 with and without anti–PD-L1 was associated with increased T-cell activation, a compensatory increase in CD73 expression, and induction of a Th1 gene expression signature consistent with immune activation. These results suggest a broad role for adenosine-mediated immunosuppression in tumors and justify the further evaluation of CPI-444 as a therapeutic agent in patients with solid tumors. Cancer Immunol Res; 6(10); 1136–49. ©2018 AACR.
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