Vascular normalizing doses of antiangiogenic treatment reprogram the immunosuppressive tumor microenvironment and enhance immunotherapy

TLDR

The recent approval of a prostate cancer vaccine has renewed hope for anticancer immunotherapies, yet the immunosuppressive tumor microenvironment limits their effectiveness, and while anti‑angiogenic agents can modulate this environment, high‑dose clinical use often prunes vessels and may compromise therapies. Lower, vascular‑normalizing doses of anti‑VEGFR2 antibody, unlike high doses, homogenize tumor vessels, shift macrophages to an M1 phenotype, boost CD4+ and CD8+ T‑cell infiltration, and when paired with a whole‑cell cancer vaccine markedly enhance CD8+ T‑cell–dependent antitumor efficacy in murine breast cancer models, indicating a more effective strategy for combining anti‑angiogenic therapy with immunotherapy.

Abstract

The recent approval of a prostate cancer vaccine has renewed hope for anticancer immunotherapies. However, the immunosuppressive tumor microenvironment may limit the effectiveness of current immunotherapies. Antiangiogenic agents have the potential to modulate the tumor microenvironment and improve immunotherapy, but they often are used at high doses in the clinic to prune tumor vessels and paradoxically may compromise various therapies. Here, we demonstrate that targeting tumor vasculature with lower vascular-normalizing doses, but not high antivascular/antiangiogenic doses, of an anti-VEGF receptor 2 (VEGFR2) antibody results in a more homogeneous distribution of functional tumor vessels. Furthermore, lower doses are superior to the high doses in polarizing tumor-associated macrophages from an immune inhibitory M2-like phenotype toward an immune stimulatory M1-like phenotype and in facilitating CD4 + and CD8 + T-cell tumor infiltration. Based on this mechanism, scheduling lower-dose anti-VEGFR2 therapy with T-cell activation induced by a whole cancer cell vaccine therapy enhanced anticancer efficacy in a CD8 + T-cell–dependent manner in both immune-tolerant and immunogenic murine breast cancer models. These findings indicate that vascular-normalizing lower doses of anti-VEGFR2 antibody can reprogram the tumor microenvironment away from immunosuppression toward potentiation of cancer vaccine therapies. Given that the combinations of high doses of bevacizumab with chemotherapy have not improved overall survival of breast cancer patients, our study suggests a strategy to use antiangiogenic agents in breast cancer more effectively with active immunotherapy and potentially other anticancer therapies.