Abstract C018: Co-activation of myeloid signaling pathways for pancreatic cancer immunotherapy

Abstract Pancreatic ductal adenocarcinoma (PDA) is characterized by a robust myeloid cell infiltrate. Although myeloid cells in PDA most commonly associate with immunosuppression, they also show plasticity and possess the capacity to engage productive anti-tumor immunity, thereby providing a potential therapeutic vulnerability. Here, we show that distinct myeloid cell subsets infiltrating human PDA express non-redundant activating receptors. Among the most highly expressed receptors was the pattern recognition receptor CLEC7A, which was expressed by macrophages, monocytes, and immature myeloid cells. In contrast, the TNF superfamily member CD40, was expressed by dendritic cells (DC) and SPP1+ macrophages. We hypothesized that combinatory targeting of myeloid activating receptors might be needed to restore productive immunosurveillance in PDA. In immune checkpoint blockade-resistant mouse models of PDA, pharmacologic activation of CLEC7A, using beta glucan (BG) therapy was associated with upregulation of the CXCL2/3-CXCR2 axis and triggered increases in intra-tumoral macrophages and granulocytes. Conversely, CD40 agonist therapy induced activity of the CXCL9-CXCR3 axis and drove conventional DC type 1-dependent infiltration of CD4+ and CD8+ T cells into tumors. Neither myeloid agonist alone, though, was sufficient to trigger durable anti-tumor immunity. By contrast, induction of both myeloid and lymphoid immunosurveillance by co-activation of CLEC7A/CD40 pathways caused tumor eradication, durable tumor control and T cell dependent immunological memory. Depletion of CSF1R+ myeloid cells or T cells significantly reduced the anti-tumor activity of treatment thereby highlighting the cooperativity of innate and adaptive immunity for anti-tumor activity. Moreover, the efficacy of CLEC7A and CD40 co-activation was independent of immune checkpoint blockade. Thus, beyond inhibitory checkpoint molecules on T cells, combinatory activation of non-redundant myeloid signaling pathways can be leveraged to trigger durable anti-tumor immunity, suggesting a new immunotherapy paradigm. A clinical trial of CLEC7A and CD40 agonist therapy for the treatment of patients with PDA is under development. Citation Format: Max M. Wattenberg, Heather Coho, Veronica M. Herrera, Kathleen Graham, Meredith L. Stone, Yuqing Xue, Renee B. Chang, Christopher Cassella, Mingen Liu, Shaanti Choi-Bose, Stacy K. Thomas, Hana Choi, Yan Li, Lauren Melendez, Michael Giannone, Nandita Bose, Gregory L. Beatty. Co-activation of myeloid signaling pathways for pancreatic cancer immunotherapy [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C018.