帕博利珠单抗联合二甲双胍治疗转移性头颈部癌的 II 期可行性研究
A Phase II Feasibility Study Combining Pembrolizumab and Metformin in Patients with Metastatic Head and Neck Cancer.
二甲双胍联合帕博利珠单抗耐受性良好,仅出现轻度胃肠道不良事件,并展现出有前景的活性,值得在随机试验中进一步研究。
英文原题:CDK4/6 Inhibitor Priming Enhances PD-1 Blockade via Sell(hi) Neutrophil-Induced Stat5a(+) Progenitor Exhausted CD8(+) T Cell.
这些发现支持进一步开展临床测试,即在抗 PD-1 治疗前短暂给予 CDK4/6i 以改善 ICB 疗效。
细胞周期通路,尤其是细胞周期蛋白D1-CDK4/6信号,在免疫治疗耐药和免疫排斥型肿瘤中富集。CDK4/6抑制剂(CDK4/6i)可同时靶向肿瘤细胞和免疫细胞,诱导抗肿瘤免疫表型并增强免疫检查点阻断(ICB)疗效,但最佳联合治疗方式及其细胞机制仍不清楚。在此,我们显示,肿瘤细胞内源性细胞周期蛋白D1-CDK4/6信号活化与头颈部鳞状细胞癌(HNSCC)中TIL(肿瘤浸润淋巴细胞)数量较少和免疫疗法耐药相关。在皮下或原位HNSCC小鼠模型中比较序贯与联合方案后发现,先给予CDK4/6i再用抗PD-1,可通过促进CD8+和CD4+ T细胞浸润并降低总体中性粒细胞数量,提高应答持久性。从机制上看,分泌IL-15的Sell高表达中性粒细胞可诱导Stat5a+前体耗竭CD8+ T细胞,参与CDK4/6i预处理策略的抗肿瘤作用。与临床相关的患者来源类器官-TIL(PDO-TIL)共培养模型结果相互印证,这些发现支持进一步开展临床研究,评估抗PD-1前短程给予CDK4/6i能否提高ICB疗效。
Cell cycle pathway, especially via cyclin D1-CDK4/6 signaling, is enriched in immunotherapy-resistant and immune-excluded tumors. CDK4/6 inhibitor (CDK4/6i) induces antitumor immune phenotypes by targeting both tumor and immune cells, enhancing immune checkpoint blockade (ICB), but optimal combination modalities and the corresponding cellular mechanisms remain unclear. Here, it is shown that activation of tumor cell-intrinsic cyclin D1-CDK4/6 signaling is associated with low tumor-infiltrating lymphocyte populations and immunotherapy resistance in head and neck squamous cell carcinoma (HNSCC). Comparison of sequential versus combinatorial regimens in subcutaneous or orthotopic HNSCC mice revealed that CDK4/6i priming before anti-PD-1 enhances response durability by promoting CD8 + and CD4 + T cell infiltration and decreasing overall neutrophil abundance. Mechanistically, IL15-secreted Sell(hi) neutrophils induced Stat5a+ progenitor exhausted CD8 + T cells contributed to the antitumor effect of CDK4/6i priming modalities. Together with corroborating evidence from a clinically relevant patient-derived-organoid-TIL (PDO-TIL) co-culture model, these findings support further clinical testing of brief CDK4/6i dosing before anti-PD-1 to improve ICB efficacy.
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