- Wang, Yujue;
- Liu, Sixue;
- Yang, Zhentao;
- Algazi, Alain P;
- Lomeli, Shirley H;
- Wang, Yan;
- Othus, Megan;
- Hong, Aayoung;
- Wang, Xiaoyan;
- Randolph, Chris E;
- Jones, Alexis M;
- Bosenberg, Marcus W;
- Byrum, Stephanie D;
- Tackett, Alan J;
- Lopez, Henry;
- Yates, Clayton;
- Solit, David B;
- Ribas, Antoni;
- Piva, Marco;
- Moriceau, Gatien;
- Lo, Roger S
Rationally sequencing and combining PD-1/L1-and MAPK-targeted therapies may overcome innate and acquired resistance. Since increased clinical benefit of MAPK inhibitors (MAPKi) is associated with previous immune checkpoint therapy, we compare the efficacies of sequential and/or combinatorial regimens in subcutaneous murine models of melanoma driven by BrafV600, Nras, or Nf1 mutations as well as colorectal and pancreatic carcinoma driven by KrasG12C. Anti-PD-1/L1 lead-in preceding MAPKi combination optimizes response durability by promoting pro-inflammatory polarization of macrophages and clonal expansion of interferon-γhi, and CD8+ cytotoxic and proliferative (versus CD4+ regulatory) T cells that highly express activation genes. Since therapeutic resistance of melanoma brain metastasis (MBM) limits patient survival, we demonstrate that sequencing anti-PD-1/L1 therapy before MAPKi combination suppresses MBM and improves mouse survival with robust T cell clonal expansion in both intracranial and extracranial metastatic sites. We propose clinically testing brief anti-PD-1/L1 (± anti-CTLA-4) dosing before MAPKi co-treatment to suppress therapeutic resistance.