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Blood, 15 March 2008, Vol. 111, No. 6, pp. 3116-3125. Prepublished online as a Blood First Edition Paper on January 17, 2008; DOI 10.1182/blood-2007-09-114371.
IMMUNOBIOLOGY Enhanced efficacy and reduced toxicity of multifactorial adjuvants compared with unitary adjuvants as cancer vaccines1 Department of Microbiology & Immunology, Dartmouth Medical School and the 2 Norris Cotton Cancer Center, Lebanon, NH; 3 Medical Oncology Immunotherapy Group, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 4 Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 5 Department of Pathology, Dartmouth Medical School, Lebanon, NH; and 6 Integrated Department of Immunology, University of Colorado Health Sciences Center, Denver Identification of Toll-like receptors (TLRs) and their ligands, and tumor necrosis factor–tumor necrosis factor receptor (TNF-TNFR) pairs have provided the first logical, hypothesis-based strategies to molecularly concoct adjuvants to elicit potent cell-mediated immunity via activation of innate and adaptive immunity. However, isolated activation of one immune pathway in the absence of others can be toxic, ineffective, and detrimental to long-term, protective immunity. Effective engineered vaccines must include agents that trigger multiple immunologic pathways. Here, we report that combinatorial use of CD40 and TLR agonists as a cancer vaccine, compared with monotherapy, elicits high frequencies of self-reactive CD8+ T cells, potent tumor-specific CD8+ memory, CD8+ T cells that efficiently infiltrate the tumor-burdened target organ; therapeutic efficacy; heightened ratios of CD8+ T cells to FoxP3+ cells at the tumor site; and reduced hepatotoxicity. These findings provide intelligent strategies for the formulation of multifactorial vaccines to achieve maximal efficacy in cancer vaccine trials in humans.
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