IAP antagonists induce anti-tumor immunity in multiple myeloma

Nat Med. 2016 Dec;22(12):1411-1420. doi: 10.1038/nm.4229. Epub 2016 Nov 14.

Abstract

The cellular inhibitors of apoptosis (cIAP) 1 and 2 are amplified in about 3% of cancers and have been identified in multiple malignancies as being potential therapeutic targets as a result of their role in the evasion of apoptosis. Consequently, small-molecule IAP antagonists, such as LCL161, have entered clinical trials for their ability to induce tumor necrosis factor (TNF)-mediated apoptosis of cancer cells. However, cIAP1 and cIAP2 are recurrently homozygously deleted in multiple myeloma (MM), resulting in constitutive activation of the noncanonical nuclear factor (NF)-κB pathway. To our surprise, we observed robust in vivo anti-myeloma activity of LCL161 in a transgenic myeloma mouse model and in patients with relapsed-refractory MM, where the addition of cyclophosphamide resulted in a median progression-free-survival of 10 months. This effect was not a result of direct induction of tumor cell death, but rather of upregulation of tumor-cell-autonomous type I interferon (IFN) signaling and a strong inflammatory response that resulted in the activation of macrophages and dendritic cells, leading to phagocytosis of tumor cells. Treatment of a MM mouse model with LCL161 established long-term anti-tumor protection and induced regression in a fraction of the mice. Notably, combination of LCL161 with the immune-checkpoint inhibitor anti-PD1 was curative in all of the treated mice.

Publication types

  • Clinical Trial, Phase II
  • Video-Audio Media
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Animals
  • Antineoplastic Agents / pharmacology
  • Antineoplastic Agents / therapeutic use*
  • Cell Line, Tumor
  • Cyclophosphamide / pharmacology
  • Dendritic Cells / drug effects
  • Dendritic Cells / immunology
  • Disease Models, Animal
  • Female
  • Gene Expression / drug effects
  • Humans
  • Inhibitor of Apoptosis Proteins / antagonists & inhibitors*
  • Interferon Type I / drug effects
  • Interferon Type I / immunology
  • Macrophages / drug effects
  • Macrophages / immunology
  • Male
  • Mice
  • Mice, Transgenic
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / immunology
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / immunology
  • Phagocytosis / drug effects
  • Phagocytosis / immunology
  • Thiazoles / pharmacology
  • Thiazoles / therapeutic use*

Substances

  • Antineoplastic Agents
  • Inhibitor of Apoptosis Proteins
  • Interferon Type I
  • LCL161
  • Thiazoles
  • Cyclophosphamide