Abstract 1652: Co-targeting distinct hallmark capabilities for therapeutic benefit in pre-clinical GBM models

Abstract Glioblastoma (GBM) is the most common primary tumor arising in the central nervous system (CNS). The currently approved standard of care has transient clinical benefit as GBM tends to be exceedingly aggressive. Despite pronounced efforts to identify novel therapies, curative options for GBM do not exist and the survival rate of diagnosed patients is very low. Therefore, there is an urgent need for new treatment strategies, and one approach would be to co-target and thereby disrupt distinct hallmarks of cancer, aiming to elicit sustained therapeutic responses. We have assessed this concept by combining a tricyclic antidepressant -imipramine - with drugs targeting VEGF-A ligand or VEGF-Receptor in mice bearing de novo GBM. All monotherapies were ineffective. In notable contradistinction, we found that combinatorial regimens significantly increased survival benefit and regressed established tumors. Investigation of the basis for the therapeutic efficacy revealed that combining the VEGF pathway inhibitor with imipramine hyperactivated autophagy to the level of eliciting cancer cell-intrinsic autophagy-associated cell death, whilst modifying the tumor vasculature to be more normal-like. In addition, imipramine downregulated an M2-like phenotype of tumor-associated macrophages and reprogramed them to express chemokines attracting otherwise rare CD8 T cells, which were demonstrably contributing to the observed efficacy. As such, these hallmark co-targeting combinations served to reprogram the GBM microenvironment from immunosuppressive to pro-inflammatory, thereby sensitizing the tumors to immune checkpoint blockade, as evidenced by enhanced responses when an anti-PD-L1 therapy was included in the mix. The results to be presented will elaborate a provocative new therapeutic approach for glioblastoma that has prospect to motivate clinical evaluation in this daunting form of human cancer. Citation Format: Agnieszka Chryplewicz, Douglas Hanahan. Co-targeting distinct hallmark capabilities for therapeutic benefit in pre-clinical GBM models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1652.