Estrogen receptor blockade and radiation therapy cooperate to enhance the response of immunologically cold ER+ breast cancer to immunotherapy

Breast Cancer Research

Research

Brian M. Burkel¹  Suzanne M. Ponik¹  Kathleen A. O’Leary²  Linda A. Schuler³  Won Jong Jin⁴  Erin J. Nystuen⁴  Amber M. Bates⁴  Sarah E. Emma⁴  Elizabeth G. Sumiec⁴  Raghava N. Sriramaneni⁴  Zachary S. Morris⁵ 

[1]Department of Cell and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA

[2]Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA

[3]Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA

[4]University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA

[5]Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA

[6]Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA

[7]University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA

关键词: ER+ breast cancer;    Anti-estrogen;    Radiation therapy;    Immunotherapy;    Fulvestrant;   

DOI  :  10.1186/s13058-023-01671-y

 received in 2023-02-20, accepted in 2023-06-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMost patients with estrogen receptor positive (ER+) breast cancer do not respond to immune checkpoint inhibition (ICI); the tumor microenvironment (TME) of these cancers is generally immunosuppressive and contains few tumor-infiltrating lymphocytes. Radiation therapy (RT) can increase tumor inflammation and infiltration by lymphocytes but does not improve responses to ICIs in these patients. This may result, in part, from additional effects of RT that suppress anti-tumor immunity, including increased tumor infiltration by myeloid-derived suppressor cells and regulatory T cells. We hypothesized that anti-estrogens, which are a standard of care for ER+ breast cancer, may ameliorate these detrimental effects of RT by reducing the recruitment/ activation of suppressive immune populations in the radiated TME, increasing anti-tumor immunity and responsiveness to ICIs.MethodsTo interrogate the effect of the selective estrogen receptor downregulator, fulvestrant, on the irradiated TME in the absence of confounding growth inhibition by fulvestrant on tumor cells, we used the TC11 murine model of anti-estrogen resistant ER+ breast cancer. Tumors were orthotopically transplanted into immunocompetent syngeneic mice. Once tumors were established, we initiated treatment with fulvestrant or vehicle, followed by external beam RT one week later. We examined the number and activity of tumor infiltrating immune cells using flow cytometry, microscopy, transcript levels, and cytokine profiles. We tested whether fulvestrant improved tumor response and animal survival when added to the combination of RT and ICI.ResultsDespite resistance of TC11 tumors to anti-estrogen therapy alone, fulvestrant slowed tumor regrowth following RT, and significantly altered multiple immune populations in the irradiated TME. Fulvestrant reduced the influx of Ly6C+Ly6G+ cells, increased markers of pro-inflammatory myeloid cells and activated T cells, and augmented the ratio of CD8+: FOXP3+ T cells. In contrast to the minimal effects of ICIs when co-treated with either fulvestrant or RT alone, combinatorial treatment with fulvestrant, RT and ICIs significantly reduced tumor growth and prolonged survival.ConclusionsA combination of RT and fulvestrant can overcome the immunosuppressive TME in a preclinical model of ER+ breast cancer, enhancing the anti-tumor response and increasing the response to ICIs, even when growth of tumor cells is no longer estrogen sensitive.

【 授权许可】

CC BY   
© The Author(s) 2023

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