Radiation-Induced Vegf-Targeted 4-1bb Costimulation Enhances Immune Control Of Tumor Growth

Radiotherapy (RT)-potentiated immunomodulation is an emerging field in solid tumor malignancies. RT induces peripheral antitumor immunity that can lead to the reduction of distant, non-irradiated tumor lesions (abscopal response). This has provided rationale for current early phase trials combining existing checkpoint blockade and co-stimulatory mAbs with stereotactic RT. Objective responses remain suboptimal with checkpoint blockade monotherapy, and dose limiting toxicity is widely observed with these modalities.  We hypothesize that targeting immunotherapy to the tumor using oligonucleotide aptamers that bind to RT induced tumor stress products will significantly enhance the therapeutic index.  We used the aptamer platform to generate a bi-specific construct containing a costimulatory aptamer ligand specific to murine 4-1BB which was conjugated to an aptamer specific to products secreted into the tumor stroma (VEGF or osteopontin). Tumor targeting, local control, abscopal responses and toxicity were compared to unconjugated 4-1BB-VEGF constructs, or mAB based therapies, when used in combination with RT in murine subcutaneous and autochthonous MCA tumor models. RT induced VEGF upregulation was demonstrated in null/low VEGF secreting tumors that led to preferential accumulation of VEGF-41BB aptamers in the irradiated tumor.12Gy x1 elicited optimal tumor targeting of bi-specific VEGF-4-1BB conjugate. Significant anti-tumor immune responses were observed in s.c. murine tumor models. This conjugate showed dramatic reduction in systemic toxicity compared to the equivalent gold standard 4-1BB mAb. RT-VEGF-4-1BB treatment significantly improved local control, overall survival and induced potent abscopal responses compared to unconjugated and non-irradiated controls in the Balb/c 4T1 and MCA murine tumor models. Furthermore, RT-VEGF-4-1BB treatment showed similar anti-tumor effects as CTLA-4 mAB with significantly less systemic toxicity. This approach increased intra-tumoral CD4 + and CD8 + T cells, the CD8 + to Treg ratio, and induced significantly more tumor cell death. In conclusion, this strategy has been shown to induce potent anti-tumor immune responses in relevant murine tumor models and significantly improves the therapeutic index over non-targeted mABs. Furthermore, radiotherapy can expand the scope of tumor targeted immune modulation to virtually all solid malignancies and induce potent abscopal responses. These results provide the rationale for developing clinical grade bispecific aptamers for future testing. Citation Format: Brett Schrand, Bhavna Verma, Agata Levay, Shradha Patel, Iris Castro, Ana Paula Benaduce, Randall Brenneman, Oliver Umland, Hideo Yagita, Eli Gilboa, Adrian Ishkanian. Radiation-induced vegf-targeted 4-1bb costimulation enhances immune control of tumor growth [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1700. doi:10.1158/1538-7445.AM2017-1700