Robust Antitumor Responses Result from Local Chemotherapy and CTLA-4 Blockade.
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| Abstract | 
   :  
              Clinical responses to immunotherapy have been associated with augmentation of preexisting immune responses, manifested by heightened inflammation in the tumor microenvironment. However, many tumors have a noninflamed microenvironment, and response rates to immunotherapy in melanoma have been <50%. We approached this problem by utilizing immunotherapy (CTLA-4 blockade) combined with chemotherapy to induce local inflammation. In murine models of melanoma and prostate cancer, the combination of chemotherapy and CTLA-4 blockade induced a shift in the cellular composition of the tumor microenvironment, with infiltrating CD8 and CD4 T cells increasing the CD8/Foxp3 T-cell ratio. These changes were associated with improved survival of the mice. To translate these findings into a clinical setting, 26 patients with advanced melanoma were treated locally by isolated limb infusion with the nitrogen mustard alkylating agent melphalan followed by systemic administration of CTLA-4 blocking antibody (ipilimumab) in a phase II trial. This combination of local chemotherapy with systemic checkpoint blockade inhibitor resulted in a response rate of 85% at 3 months (62% complete and 23% partial response rate) and a 58% progression-free survival at 1 year. The clinical response was associated with increased T-cell infiltration, similar to that seen in the murine models. Together, our findings suggest that local chemotherapy combined with checkpoint blockade-based immunotherapy results in a durable response to cancer therapy. .  | 
        
| Year of Publication | 
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              2018 
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| Journal | 
   :  
              Cancer immunology research 
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| Volume | 
   :  
              6 
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| Issue | 
   :  
              2 
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| Number of Pages | 
   :  
              189-200 
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| ISSN Number | 
   :  
              2326-6066 
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| URL | 
   :  
              http://cancerimmunolres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=29339377 
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| DOI | 
   :  
              10.1158/2326-6066.CIR-17-0356 
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| Short Title | 
   :  
              Cancer Immunol Res 
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