Abstract 6522: Epigenetic modulation decreases myeloid suppression to improve response to immune checkpoint inhibition in breast cancer
Authors: Baugh Aaron G. , Gonzalez Edgar , Kreger Jesse , Liu Yingtong , Al-Zubeidy Batul , Danilova Ludmila , Shin Sarah M. , Narumi Valerie H. , Castanon Sofi , Jang Julie , Fertig Elana J. , Cimino-Mathews Ashley , Jaffee Elizabeth M. , Stearns Vered , Connolly Roisin M. , Ho Won Jin , MacLean Adam , Roussos Torres Evanthia T. 
Published: March 2024

Abstract
Immune checkpoint inhibitors (ICIs) promote a durable anti-tumor immune response. Unfortunately, many patients with breast cancer are thought to be intrinsically resistant. One potential mechanism of resistance is a myeloid suppressed tumor microenvironment (TME). Targeting myeloid suppression is under investigation as a therapeutic strategy to sensitize tumors to ICI. In our trial, NCI-9844, we demonstrated that the combination of the epigenetic modulator, entinostat with ICIs—nivolumab (anti-PD-1) + ipilimumab (anti-CTLA-4), leads to a 25% objective response rate in patients with advanced breast cancer. Work in our preclinical models showed entinostat decreases suppressive function by myeloid derived suppressor cells (MDSCs). We hypothesized that entinostat decreases intra-tumoral MDSC suppression via the STAT3/AP-1 axis and drives cellular shifts within the TME to improve response to ICI. Here, we examined expression of upstream, downstream, and interacting factors within the STAT3 pathway in MDSCs treated with entinostat. Macro-dissected lung metastases from entinostat treated NeuN mice revealed differential gene expression of AP-1 subunits JunB and FOSL1 in MDSCs identified by single cell RNA sequencing (scRNAseq). Western blot of isolated intratumoral MDSCs from lung metastases revealed decreased STAT3 phosphorylation upon entinostat treatment. In an entinostat treated MDSC-like cell line, J774M, JunB phosphorylation and FOSL1 were both decreased. scRNAseq also revealed decreased gene expression of STAT3 upstream receptors IL4RA and IFNGR1 and increased expression of STAT3 negative regulator SOCS3. Chromatin immunoprecipitation sequencing is planned to further narrow the molecular mechanism of action. Cell-cell communication analysis of scRNAseq data was performed to evaluate the contribution of entinostat treated macrophages, dendritic cells (DCs), and natural killer (NK) cells on MDSC function. We observed increased frequency of DC populations (classic DC2s and Ccr7 DCs). Following combined treatment with entinostat + ICIs, we also found increased DC to T cell signaling strength for receptor-ligand pairs involved in T cell activation, including Tnfsf9__Tnfrsf9, Cd70_Cd27, H2-dmb2_Cd4, and Cd80_Cd28. Analysis of macrophage-T cell interactions revealed a synergistic decrease in signaling associated with immunosuppression after combined treatment, such as Cd80_Ctla4, Tnf_Tnfrsf1b, and Entpd1_Adora2a. Suppressive function of treated sub-populations of macrophages is planned to determine functional effect of findings. Finally, we are using imaging mass cytometry and bulk RNA sequencing to evaluate proposed mechanisms in patient specimens (NCI-9844). The goal of this work is to identify the molecular and cellular mechanisms driving myeloid suppression of the TME thereby identifying potential therapeutic targets.
Citation Format: Aaron G. Baugh, Edgar Gonzalez, Jesse Kreger, Yingtong Liu, Batul Al-Zubeidy, Ludmila Danilova, Sarah M. Shin, Valerie H. Narumi, Sofi Castanon, Julie Jang, Elana J. Fertig, Ashley Cimino-Mathews, Elizabeth M. Jaffee, Vered Stearns, Roisin M. Connolly, Won Jin Ho, Adam MacLean, Evanthia T. Roussos Torres. Epigenetic modulation decreases myeloid suppression to improve response to immune checkpoint inhibition in breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6522.