Cancer regression and autoimmunity induced by cytotoxic T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma

Giao Q. Phan(National Institutes of Health), James Chih‐Hsin Yang(National Institutes of Health), Richard M. Sherry(National Institutes of Health), Patrick Hwu(National Institutes of Health), Suzanne L. Topalian(National Institutes of Health), Douglas J. Schwartzentruber(National Institutes of Health), Nicholas P. Restifo(National Institutes of Health), Leah Haworth(National Institutes of Health), Claudia A. Seipp(National Institutes of Health), Linda J. Freezer(National Institutes of Health), Kathleen E. Morton(National Institutes of Health), Sharon Mavroukakis(National Institutes of Health), Paul H. Duray(National Institutes of Health), Seth M. Steinberg(National Institutes of Health), James P. Allison(National Institutes of Health), Thomas A. Davis(National Institutes of Health), Steven A. Rosenberg(National Institutes of Health)
Proceedings of the National Academy of Sciences
June 25, 2003
10.1073/pnas.1533209100
Cited by 1,571Open Access
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Abstract

Cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) is a critical immunoregulatory molecule (expressed on activated T cells and a subset of regulatory T cells) capable of down-regulating T cell activation. Blockade of CTLA-4 has been shown in animal models to improve the effectiveness of cancer immunotherapy. We thus treated 14 patients with metastatic melanoma by using serial i.v. administration of a fully human anti-CTLA-4 antibody (MDX-010) in conjunction with s.c. vaccination with two modified HLA-A*0201-restricted peptides from the gp100 melanoma-associated antigen, gp100:209-217(210M) and gp100:280-288(288V). This blockade of CTLA-4 induced grade III/IV autoimmune manifestations in six patients (43%), including dermatitis, enterocolitis, hepatitis, and hypophysitis, and mediated objective cancer regression in three patients (21%; two complete and one partial responses). This study establishes CTLA-4 as an important molecule regulating tolerance to "self" antigens in humans and suggests a role for CTLA-4 blockade in breaking tolerance to human cancer antigens for cancer immunotherapy.

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