Dual blockade of CXCL12‐CXCR4 and PD‐1–PD‐L1 pathways prolongs survival of ovarian tumor–bearing mice by prevention of immunosuppression in the tumor microenvironment

ABSTRACT Blockade of immune‐checkpoint programmed cell death protein 1 (PD‐1) or programmed cell death ligand 1 can enhance effector T‐cell responses. However, the lack of response in many patients to checkpoint‐inhibitor therapies emphasizes the need for combination immunotherapies to pursue maximal antitumor efficacy. We have previously demonstrated that antagonism of C‐X‐C chemokine receptor type 4 (CXCR4) by plerixafor (AMD3100) can decrease regulatory T (T reg )‐cell intratumoral infiltration. Therefore, a combination of these 2 therapies might increase antitumor effects. Here, we evaluated the antitumor efficacy of AMD3100 and anti‐PD‐1 (αPD‐1) antibody alone or in combination in an immunocompetent syngeneic mouse model of ovarian cancer. We found that AMD3100, a highly specific CXCR4 antagonist, directly down‐regulated the expression of both C‐X‐C motif chemokine 12 (CXCL12) and CXCR4 in vitro and in vivo in tumor cells. AMD3100 and αPD‐1 significantly inhibited tumor growth and prolonged the survival of tumor‐bearing mice when given as monotherapy. Combination of these 2 agents significantly enhanced antitumor effects compared with single‐agent administration. Benefits of tumor control and animal survival were associated with immunomodulation mediated by these 2 agents, which were characterized by increased effector T‐cell infiltration, increased effector T‐cell function, and increased memory T cells in tumor microenvironment. Intratumoral T reg cells were decreased, and conversion of T reg cells into T helper cells was increased by AMD3100 treatment. Intratumoral myeloid‐derived suppressor cells were decreased by the combined treatment, which was associated with decreased IL‐10 and IL‐6 in the ascites. Also, the combination therapy decreased suppressive leukocytes and facilitated M2‐to‐M1 macrophage polarization in the tumor. These results suggest that AMD3100 could be used to target the CXCR4‐CXCL12 axis to inhibit tumor growth and prevent multifaceted immunosuppression alone or in combination with αPD‐1 in ovarian cancer, which could be clinically relevant to patients with this disease.—Zeng, Y., Li, B., Liang, Y., Reeves, P. M., Qu, X., Ran, C., Liu, Q., Callahan, M. V., Sluder, A. E., Gelfand, J. A., Chen, H., Poznansky, M. C. Dual blockade of CXCL12‐CXCR4 and PD‐1‐PD‐L1 pathways prolongs survival of ovarian tumor‐bearing mice by prevention of immunosuppression in the tumor microenvironment. FASEB J. 33, 6596–6608 (2019). www.fasebj.org