Immunothérapie non-spécifique du cancer de la vessie : développement de nouvelles approches basées sur la combinaison d'agents thérapeutiques

Authors: Besancon, Marjorie
Advisor: Fradet, YvesBergeron, Alain
Abstract: Bladder cancer (BCa) is the ninth most common cancer in the world, with 430 000 new cases diagnosed in 2014. Muscle-invasive bladder cancer represents about 25% of bladder tumors, while non-muscle-invasive bladder cancer represents about 75% of these tumors. The latter are usually associated with a favorable prognosis but are characterized by a high rate of recurrence and progression while the former are aggressive from the onset and are at high risk of progression toward advanced disease. Among the various therapies available for the management of bladder tumors is non-specific immunotherapy using bacillus Calmette-Guerin (BCG) for the treatment on non-muscle invasive bladder tumors and, more recently, inhibitors of immune checkpoint (IC) for the treatment of advanced bladder tumors. BCa is one of the rare cancers to respond well to immunotherapy but, nevertheless, these treatments are suboptimal. The main objective of my project was to develop new immunotherapeutic approaches to fight more efficiently against BCa. To achieve this, three complementary approaches were investigated in murine BCa models. We first assessed in vitro and in vivo the potential of poly(I:C), a TLR3 agonist, used alone or in combination with BCG. While poly(I:C) induced anti-proliferative and apoptotic effects on BCa cells in vitro, the combination of poly(I:C) and BCG induced in vivo a complete tumor regression in 28% of treated mice. Then, we evaluated the potential of two combinations of IC inhibitors in two murine BCa models. The first combination studied was that of the simultaneous blockade of PD-1 and TIM-3 tested in the MBT-2 model because the characterization of the MBT-2 tumors showed that these two receptors where frequently IC expressed in these tumors. In vivo blockade of these pathways revealed that in MBT-2 tumors, PD-1 is associated to a pro-tumoral activity, whereas, TIM-3 is associated with anti-tumoral activity, revealing opposite functions of these IC in these tumors. The second combination studied was that of PD-1 and LAG-3 tested in the MB49 BCa model. The characterization of MB49 tumors showed that PD-1 and LAG-3 were important IC in these tumors. The in vivo study showed that the simultaneous blockade of PD-1 and LAG-3 increased the survival rate, since 67% of mice showed a complete tumor regression while the survival rates were 33% and 0% when anti-PD-1 and anti-LAG-3, respectively, were used in monotherapy. Finally, since androgens seem to play an important role in BCa, we tested an approach combining the inhibition of PD-1 and of the androgen receptor (AR). We showed that enzalutamide and seviteronel, two second generation antiandrogens, induced in vitro a decrease of the proliferation of human and murine BCa cells. In vivo, the combination of enzalutamide with anti-PD-1 showed a 66% overall survival rate, a rate that is much higher than the 16% rate observed when enzalutamide or anti-PD-1 were used alone. Thus, these studies allowed us to identify various possible ways to increase anti-tumor immune response that could be tested in clinical trials. They also show that the combination of therapeutic approaches is very promising the future of BCa immunotherapy.
Document Type: Thèse de doctorat
Issue Date: 2017
Open Access Date: 24 April 2018
Grantor: Université Laval
Collection:Thèses et mémoires

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