Cyclophosphamide enhances cancer antibody immunotherapy in the resistant bone marrow niche by modulating macrophage FcγR expression

A Roghanian, G Hu, C Fraser, M Singh, RB Foxall… - Cancer immunology …, 2019 - AACR
A Roghanian, G Hu, C Fraser, M Singh, RB Foxall, MJ Meyer, E Lees, H Huet, MJ Glennie
Cancer immunology research, 2019AACR
Therapy-resistant microenvironments represent a major barrier toward effective elimination
of disseminated cancer. Many hematologic and solid tumors are resistant to therapeutic
antibodies in the bone marrow (BM), but not in the periphery (eg, spleen). We previously
showed that cyclophosphamide (CTX) sensitizes the BM niche to antibody therapeutics.
Here, we show that (i) BM resistance was induced not only by the tumor but also by the
intrinsic BM microenvironment;(ii) CTX treatment overcame both intrinsic and extrinsic …
Abstract
Therapy-resistant microenvironments represent a major barrier toward effective elimination of disseminated cancer. Many hematologic and solid tumors are resistant to therapeutic antibodies in the bone marrow (BM), but not in the periphery (e.g., spleen). We previously showed that cyclophosphamide (CTX) sensitizes the BM niche to antibody therapeutics. Here, we show that (i) BM resistance was induced not only by the tumor but also by the intrinsic BM microenvironment; (ii) CTX treatment overcame both intrinsic and extrinsic resistance mechanisms by augmenting macrophage activation and phagocytosis, including significant upregulation of activating Fcγ receptors (FcγRIII and FcγRIV) and downregulation of the inhibitory receptor, FcγRIIB; and (iii) CTX synergized with cetuximab (anti-EGFR) and trastuzumab (anti-Her2) in eliminating metastatic breast cancer in the BM of humanized mice. These findings provide insights into the mechanisms by which CTX synergizes with antibody therapeutics in resistant niche-specific organs and its applicability in treating BM-resident tumors.
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