Sculpting the tumour microenvironment by combining radiotherapy and ATR inhibition for curative-intent anti-PD-L1- and anti-NKG2A-based adjuvant immunotherapy

Despite some success in other cancer types, the results of combining radiotherapy/chemoradiotherapy and immune checkpoint blockade have been disappointing in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). For such a potentially radiocurable disease, there remains an imperative to explore novel combination approaches. Here, we show that combining ATR inhibition with radiotherapy (ATRi/RT) increases the frequency of highly activated NKG2A/PD-1 double-positive T cells in patients and in animal models of HNSCC. Addition of dual anti-NKG2A and anti-PD-1/-PD-L1 blockade to ATRi/RT in the adjuvant, post-radiotherapy setting induces a robust antitumour immune response in HNSCC preclinical models. Efficacy of the combination regimen relies on CD40/CD40L costimulatory-mediated infiltration of activated/proliferative/memory CD8 and CD4 conventional T cells with persistent or new T cell receptor (TCR) signalling, respectively, as defined by tracking of T cell dynamics. In this favourable therapeutic context, TCR sequencing shows increased richness of the TCR repertoire and the emergence of numerous and large TCR clusters that share antigen specificity in response to full combination therapy. Collectively, our data point towards promising combination approaches for future clinical testing in HNSCC.  ### Competing Interest Statement The authors have declared no competing interest.