Intermittent PI3Kδ inhibition sustains anti-tumour immunity and curbs irAEs.
Intermittent PI3Kδ inhibition sustains anti-tumour immunity and curbs irAEs.
Phosphoinositide 3-kinase δ (PI3Kδ) has a key role in lymphocytes, and inhibitors that target this PI3K have been approved for treatment of B cell malignancies1-3. Although studies in mouse models of solid tumours have demonstrated that PI3Kδ inhibitors (PI3Kδi) can induce anti-tumour immunity4,5, its effect on solid tumours in humans remains unclear. Here we assessed the effects of the PI3Kδi AMG319 in human patients with head and neck cancer in a neoadjuvant, double-blind, placebo-controlled randomized phase II trial (EudraCT no. 2014-004388-20). PI3Kδ inhibition decreased the number of tumour-infiltrating regulatory T (Treg) cells and enhanced the cytotoxic potential of tumour-infiltrating T cells. At the tested doses of AMG319, immune-related adverse events (irAEs) required treatment to be discontinued in 12 out of 21 of patients treated with AMG319, suggestive of systemic effects on Treg cells. Accordingly, in mouse models, PI3Kδi decreased the number of Treg cells systemically and caused colitis. Single-cell RNA-sequencing analysis revealed a PI3Kδi-driven loss of tissue-resident colonic ST2 Treg cells, accompanied by expansion of pathogenic T helper 17 (TH17) and type 17 CD8+ T (TC17) cells, which probably contributed to toxicity; this points towards a specific mode of action for the emergence of irAEs. A modified treatment regimen with intermittent dosing of PI3Kδi in mouse models led to a significant decrease in tumour growth without inducing pathogenic T cells in colonic tissue, indicating that alternative dosing regimens might limit toxicity.
741-746
Eschweiler, Simon
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Ramírez-suástegui, Ciro
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Li, Yingcong
1999b484-e160-46b1-a3ba-280daab80828
King, Emma
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Chudley, Lindsey
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Jaya, Thomas
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Wood, Oliver
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Witzleben, Adrian von
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Jeffrey, Danielle
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Mccann, Katy
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Singh, Rabindra P.
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Thomas, Gareth
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Vijayanand, Pandurangan
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Ottensmeier, Christian H.
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26 May 2022
Eschweiler, Simon
fa58c5a9-20b9-4ab3-94c0-677e6bc2e9e9
Ramírez-suástegui, Ciro
d974b1fe-f22e-46bf-8da9-884ff8459540
Li, Yingcong
1999b484-e160-46b1-a3ba-280daab80828
King, Emma
d85e0e8f-7295-4912-9052-646a790d99db
Chudley, Lindsey
ad364505-e3c8-4d6d-8f25-aa80cb7636fe
Jaya, Thomas
109d22c0-1e01-4e72-a07c-980938244718
Wood, Oliver
b9b57016-5f60-466c-983f-38958426c4b5
Witzleben, Adrian von
cb3adebe-4aa8-4723-95ff-4649913d1aac
Jeffrey, Danielle
6dd0239c-4d4a-4531-8e25-42a7b1176a4f
Mccann, Katy
154f6b6d-c8b2-43b2-a8a9-ffe243da40c6
Singh, Rabindra P.
2d7bfc81-9d61-4a04-871b-5e87bb5bda47
Thomas, Gareth
2ff54aa9-a766-416b-91ee-cf1c5be74106
Vijayanand, Pandurangan
048179ec-320b-469e-b9a2-28243bcb0f5d
Ottensmeier, Christian H.
6805eed3-1cf2-4083-bd11-b49817c24cb1
Eschweiler, Simon, Ramírez-suástegui, Ciro, Li, Yingcong, King, Emma, Chudley, Lindsey, Jaya, Thomas, Wood, Oliver, Witzleben, Adrian von, Jeffrey, Danielle, Mccann, Katy, Singh, Rabindra P., Thomas, Gareth, Vijayanand, Pandurangan and Ottensmeier, Christian H.
(2022)
Intermittent PI3Kδ inhibition sustains anti-tumour immunity and curbs irAEs.
Nature, 605 (7911), , [10.1038/s41586-022-04685-2].
(doi:10.1038/s41586-022-04685-2).
Abstract
Phosphoinositide 3-kinase δ (PI3Kδ) has a key role in lymphocytes, and inhibitors that target this PI3K have been approved for treatment of B cell malignancies1-3. Although studies in mouse models of solid tumours have demonstrated that PI3Kδ inhibitors (PI3Kδi) can induce anti-tumour immunity4,5, its effect on solid tumours in humans remains unclear. Here we assessed the effects of the PI3Kδi AMG319 in human patients with head and neck cancer in a neoadjuvant, double-blind, placebo-controlled randomized phase II trial (EudraCT no. 2014-004388-20). PI3Kδ inhibition decreased the number of tumour-infiltrating regulatory T (Treg) cells and enhanced the cytotoxic potential of tumour-infiltrating T cells. At the tested doses of AMG319, immune-related adverse events (irAEs) required treatment to be discontinued in 12 out of 21 of patients treated with AMG319, suggestive of systemic effects on Treg cells. Accordingly, in mouse models, PI3Kδi decreased the number of Treg cells systemically and caused colitis. Single-cell RNA-sequencing analysis revealed a PI3Kδi-driven loss of tissue-resident colonic ST2 Treg cells, accompanied by expansion of pathogenic T helper 17 (TH17) and type 17 CD8+ T (TC17) cells, which probably contributed to toxicity; this points towards a specific mode of action for the emergence of irAEs. A modified treatment regimen with intermittent dosing of PI3Kδi in mouse models led to a significant decrease in tumour growth without inducing pathogenic T cells in colonic tissue, indicating that alternative dosing regimens might limit toxicity.
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More information
Accepted/In Press date: 24 March 2022
e-pub ahead of print date: 4 May 2022
Published date: 26 May 2022
Additional Information:
Funding Information:
G.F. is an employee of Amgen Inc. B.V. is a consultant for iOnctura (Geneva, Switzerland), Venthera (Palo Alto, US) and Olema Pharmaceuticals (San Francisco, US) and has received speaker fees from Gilead (Foster City, US). K.O. has received consultancy fees from iOnctura, Macomics, Gilead Sciences and Karus Therapeutics and has received research funding from GSK. M.K. is on the scientific advisory board of Prometheus. C.H.O. led the clinical trial of AMG319 with funding by Cancer Research UK, Amgen provided clinical grade compound free of charge for this trial. All other authors declare no conflicts of interest.
Funding Information:
We thank C. Rommel, K. Ali, P. Johnson and D. Scott for support and help during the initial phases of setting up the CRUK/Amgen collaboration; F. Martin for project support over the years; M. Lopez and the research pathology core at University Hospital Southampton for performing the immunohistochemistry on the paraffin embedded material; I. Henderson for help with the tetanus ELISAs; the La Jolla Institute (LJI) Flow Cytometry Core for assisting with cell sorting; the LJI sequencing core for the bulk and single-cell sequencing; the LJI histology core for processing the mouse histology samples; G. Means for method and training for the phospho-AKT assays; P. Friedmann for constructive critique of the paper; and D. Singh for advice on and help with experimental work. This clinical trial work was funded by a CDD trial Grant CRUKD/15/004 (C.H.O.), a Cancer Research UK Centres Network Accelerator Award Grant (A21998) (O.W., K.M. and J.T.), the CRUK and NIHR Experimental Cancer Medicine Center (ECMC) Southampton (A15581), the CRUK and NIHR ECMC Liverpool (A25153), Cancer Research UK Programme Grant (C23338/A25722 (E.L.-G. and B.V.)); the UK NIHR UCLH Biomedical Research Centre (B.V.), S10OD025052 (Illumina Novaseq6000), S10RR027366 (FACSAria II cell sorter), NIH grant P01 DK46763 (M.K.), the William K. Bowes Jr Foundation (P.V.), Whittaker iCure Foundation (P.V., L.C. and C.H.O.), the Deutsche Forschungsgemeinschaft DFG research fellowship no. WI 5255/1-1:1 (A.v.W.) and Erwin Schrödinger Fellowship (M.D.). The clinical delivery of this work was supported by the Wessex Clinical Research Network and National Institute of Health Research UK. We further acknowledge Cancer Research UK (Centre for Drug Development) as the clinical trial Sponsor and for funding and management of the Phase II clinical trial, as well as Amgen for supply of the PI3Kδi AMG319.
Funding Information:
We thank C. Rommel, K. Ali, P. Johnson and D. Scott for support and help during the initial phases of setting up the CRUK/Amgen collaboration; F. Martin for project support over the years; M. Lopez and the research pathology core at University Hospital Southampton for performing the immunohistochemistry on the paraffin embedded material; I. Henderson for help with the tetanus ELISAs; the La Jolla Institute (LJI) Flow Cytometry Core for assisting with cell sorting; the LJI sequencing core for the bulk and single-cell sequencing; the LJI histology core for processing the mouse histology samples; G. Means for method and training for the phospho-AKT assays; P. Friedmann for constructive critique of the paper; and D. Singh for advice on and help with experimental work. This clinical trial work was funded by a CDD trial Grant CRUKD/15/004 (C.H.O.), a Cancer Research UK Centres Network Accelerator Award Grant (A21998) (O.W., K.M. and J.T.), the CRUK and NIHR Experimental Cancer Medicine Center (ECMC) Southampton (A15581), the CRUK and NIHR ECMC Liverpool (A25153), Cancer Research UK Programme Grant (C23338/A25722 (E.L.-G. and B.V.)); the UK NIHR UCLH Biomedical Research Centre (B.V.), S10OD025052 (Illumina Novaseq6000), S10RR027366 (FACSAria II cell sorter), NIH grant P01 DK46763 (M.K.), the William K. Bowes Jr Foundation (P.V.), Whittaker iCure Foundation (P.V., L.C. and C.H.O.), the Deutsche Forschungsgemeinschaft DFG research fellowship no. WI 5255/1-1:1 (A.v.W.) and Erwin Schrödinger Fellowship (M.D.). The clinical delivery of this work was supported by the Wessex Clinical Research Network and National Institute of Health Research UK. We further acknowledge Cancer Research UK (Centre for Drug Development) as the clinical trial Sponsor and for funding and management of the Phase II clinical trial, as well as Amgen for supply of the PI3Kδi AMG319.
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© 2022, The Author(s).
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Local EPrints ID: 468648
URI: http://eprints.soton.ac.uk/id/eprint/468648
ISSN: 0028-0836
PURE UUID: 70d2556e-081a-4aa5-86ae-45232c985b23
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Date deposited: 19 Aug 2022 16:38
Last modified: 16 Mar 2024 21:46
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Contributors
Author:
Simon Eschweiler
Author:
Ciro Ramírez-suástegui
Author:
Yingcong Li
Author:
Lindsey Chudley
Author:
Thomas Jaya
Author:
Oliver Wood
Author:
Adrian von Witzleben
Author:
Danielle Jeffrey
Author:
Katy Mccann
Author:
Rabindra P. Singh
Author:
Pandurangan Vijayanand
Author:
Christian H. Ottensmeier
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