Order of administration of combination cytokine therapies can decouple toxicity from efficacy in syngeneic mouse tumor models

Adrienne Rothschilds; Alice Tzeng; Naveen K Mehta; Kelly D Moynihan; Darrell J Irvine; K Dane Wittrup

doi:10.1080/2162402X.2018.1558678

Order of administration of combination cytokine therapies can decouple toxicity from efficacy in syngeneic mouse tumor models

Oncoimmunology. 2019 Feb 19;8(5):e1558678. doi: 10.1080/2162402X.2018.1558678. eCollection 2019.

Authors

Adrienne Rothschilds^{1

2}, Alice Tzeng^{1

2}, Naveen K Mehta^{1

2}, Kelly D Moynihan^{1

2

3}, Darrell J Irvine^{1

2

3

4

5}, K Dane Wittrup^{1

2

6}

Affiliations

¹ Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
² Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
³ Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁴ Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁵ Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁶ Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.

Abstract

In combination cancer immunotherapies, consideration should be given to designing treatment schedules that harmonize with the immune system's natural timing. An efficacious temporally programmed combination therapy of extended half-life interleukin 2 (eIL2), tumor targeting antibody, and interferon (IFN) α was recently reported; however, tumor-ablative efficacy was associated with significant toxicity. In the current work, altering the order and timing of the three agents is shown to decouple toxicity from efficacy. Delaying the administration of eIL2 to be concurrent with or after IFNα eliminates toxicity without affecting efficacy in multiple syngeneic tumor models and mouse strains. The toxicity resulting from eIL2 administration before IFNα is dependent on multiple systemic inflammatory cytokines including IL6, IL10, IFNγ, and tumor necrosis factor α. Natural killer (NK) cells are the main cellular contributor to toxicity, but are not essential for tumor control in this system. When pre-conditioned with eIL2, splenic NK cells became hyper-activated and upregulate IFNα signaling proteins that cause an excessive, toxic response to subsequent IFNα exposure. This work illustrates an example where accounting for the temporal dynamics of the immune system in combination therapy treatment schedule can favorably decouple efficacy and toxicity.

Keywords: Dose scheduling; cytokines; timing; toxicity.

Publication types

Research Support, N.I.H., Extramural

Grants and funding

This work was supported by the National Cancer Institute [CA174795]