Ye, Jian, Qin, Shuyang S., Hughson, Angela L., Hannon, Gary, Vrooman, Tara G., Lesch, Maggie L., Eckl, Sarah L., Benoodt, Lauren, Mills, Bradley N., Lord, Edith M., Belt, Brian A., Linehan, David C., Luheshi, Nadia, Eyles, Jim, and Gerber, Scott A.
Simple Summary: LIF has emerged as a key target in pancreatic cancer (PDAC) due to its role in promoting chemoresistance by driving tumor progression and promoting an immunosuppressive tumor microenvironment. Early clinical trial data testing anti-LIF treatment in patients proved safe but with limited efficacy, suggesting the need to be combined with other therapies such as chemotherapy or immunotherapy. The aim of this study was to assess the antitumor efficacy and mechanism of action resulting from combination therapy consisting of chemotherapy (gemcitabine/nab-paclitaxel), anti-LIF, and anti-PD-L1 in mouse models of PDAC. We demonstrated that this triple combination therapy significantly improved antitumor efficacy compared to monotherapy or dual combinations of these therapies. Mechanistically, this combination therapy not only reduced the aggressiveness of tumor cells but also enhanced antitumor immunity, especially through CD8 T cells. Our preclinical data provide the rationale for ongoing or future clinical trials investigating the combination of anti-PD-L1 with anti-LIF and chemotherapy in PDAC. Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC), expecting to be the second leading cause of cancer deaths by 2030, resists immune checkpoint therapies due to its immunosuppressive tumor microenvironment (TME). Leukemia inhibitory factor (LIF) is a key target in PDAC, promoting stemness, epithelial–mesenchymal transition (EMT), and therapy resistance. Phase 1 clinical trials showed anti-LIF therapy is safe but with limited efficacy, suggesting better outcomes when combined with chemotherapy, radiotherapy, or immunotherapy. Methods: We assessed the combination of chemotherapy (gemcitabine/nab-paclitaxel) and dual blockade of LIF and PD-L1 on tumor growth and survival in orthotopic and spontaneous PDAC models. Flow cytometry and scRNA-seq were utilized to monitor the antitumor immune response. The role of key immune cells was further confirmed by depleting these immune cells, including CD4, CD8, or inflammatory monocytes. Results: Sequential treatment with chemotherapy (gemcitabine/nab-paclitaxel) and dual blockade of LIF and PD-L1 significantly improved antitumor efficacy compared to monotherapy or dual combinations of these therapies. This chemo/anti-LIF/anti-PD-L1 approach reduced EMT in tumor cells and enhanced the antitumor immune response, primarily through CD8 T cells, as depleting CD8 cells largely abrogated the effect of treatment. This combination therapy also shifted macrophages and dendritic cells towards an antitumor phenotype. Conclusions: The combination of chemotherapy, anti-LIF, and anti-PD-L1 not only targeted tumor cells but also augmented the anti-tumor immune response. These findings strongly support advancing chemo/anti-LIF/anti-PD-L1 combination therapy to clinical trials in PDAC. [ABSTRACT FROM AUTHOR]