Preclinical Development of Ipilimumab and Nivolumab Combination Immunotherapy: Mouse Tumor Models, In Vitro Functional Studies, and Cynomolgus Macaque Toxicology

PLoS One. 2016 Sep 9;11(9):e0161779. doi: 10.1371/journal.pone.0161779. eCollection 2016.

Abstract

The monoclonal antibodies ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) have shown remarkable antitumor activity in an increasing number of cancers. When combined, ipilimumab and nivolumab have demonstrated superior activity in patients with metastatic melanoma (CHECKMATE-067). Here we describe the preclinical development strategy that predicted these clinical results. Synergistic antitumor activity in mouse MC38 and CT26 colorectal tumor models was observed with concurrent, but not sequential CTLA-4 and PD-1 blockade. Significant antitumor activity was maintained using a fixed dose of anti-CTLA-4 antibody with decreasing doses of anti-PD-1 antibody in the MC38 model. Immunohistochemical and flow cytometric analyses confirmed that CD3+ T cells accumulated at the tumor margin and infiltrated the tumor mass in response to the combination therapy, resulting in favorable effector and regulatory T-cell ratios, increased pro-inflammatory cytokine secretion, and activation of tumor-specific T cells. Similarly, in vitro studies with combined ipilimumab and nivolumab showed enhanced cytokine secretion in superantigen stimulation of human peripheral blood lymphocytes and in mixed lymphocyte response assays. In a cynomolgus macaque toxicology study, dose-dependent immune-related gastrointestinal inflammation was observed with the combination therapy; this response had not been observed in previous single agent cynomolgus studies. Together, these in vitro assays and in vivo models comprise a preclinical strategy for the identification and development of highly effective antitumor combination immunotherapies.

MeSH terms

  • Animals
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • CTLA-4 Antigen / antagonists & inhibitors
  • CTLA-4 Antigen / metabolism
  • Cell Line, Tumor
  • Cells, Cultured
  • Colorectal Neoplasms / metabolism
  • Colorectal Neoplasms / therapy
  • Combined Modality Therapy
  • Disease Models, Animal
  • Female
  • Humans
  • Immunotherapy*
  • Ipilimumab
  • Lymphocytes / immunology
  • Lymphocytes / metabolism
  • Macaca fascicularis
  • Melanoma / drug therapy*
  • Melanoma / metabolism
  • Melanoma / therapy
  • Mice
  • Mice, Inbred C57BL
  • Nivolumab
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • Programmed Cell Death 1 Receptor / metabolism
  • T-Lymphocytes, Regulatory / metabolism

Substances

  • Antibodies, Monoclonal
  • CTLA-4 Antigen
  • Ipilimumab
  • Programmed Cell Death 1 Receptor
  • Nivolumab

Grants and funding

The studies described in this manuscript were sponsored by Bristol-Myers Squibb. The funder provided support in the form of salaries for all authors (MJS JJE RJJ LL MH KT DY MQ JV CW BC PMC DB AJK) and was involved in study design, data collection and analysis, decision to publish, and preparation of the manuscript. The specific roles of these authors are articulated in the Authors’ Contributions section. In addition, the funder provided support in the form of salaries to individuals listed in the Acknowledgements section (LW MS IC CB).