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Report on the 2018 Cancer, Autoimmunity, and Immunology Conference Colleen S. Curran, Connie L. Sommers, Howard A. Young, Katarzyna Bourcier, Marie Mancini and Elad Sharon This information is current as of September 28, 2021. J Immunol 2019; 202:2823-2828; Prepublished online 15 April 2019; doi: 10.4049/jimmunol.1900264 http://www.jimmunol.org/content/202/10/2823 Downloaded from References This article cites 15 articles, 6 of which you can access for free at: http://www.jimmunol.org/content/202/10/2823.full#ref-list-1 http://www.jimmunol.org/ Why The JI? Submit online. • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication by guest on September 28, 2021 *average Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. Report on the 2018 Cancer, Autoimmunity, and Immunology Conference † ‡ x Colleen S. Curran,*{ Connie L. Sommers,‖ Howard A. Young, Katarzyna Bourcier, Marie Mancini, and Elad Sharon With the increased use of cancer immunotherapy, a immune-related adverse events (irAEs) that accompany cancer number of immune-related adverse events (irAEs) are immunotherapy. After an introduction to the recent history being identified. These irAEs can be compared with of cancer immunotherapy and the definition and recognition known autoimmune disorders in similar tissues, with of irAEs by Anthony Fauci (National Institute of Allergy important similarities and differences. Understanding and Infectious Diseases [NIAID]), Dr. Topalian focused on the etiology of irAEs may bring to light concepts appli- irAEs that result from immune checkpoint blockade therapy. cable to immune responses in cancer, autoimmunity, She described how T cells are activated by signal 1 (through Downloaded from and infectious disease. This immunobiology is espe- the T cell Ag receptor) and signal 2 (through coreceptors). cially relevant to cancer patients with preexisting allo- Checkpoint molecules expressed on the surface of T cells (such geneic transplants or autoimmune disease who are as PD-1 and CTLA-4) normally restrain the T cell activation undergoing cancer immunotherapy. To address these response from becoming too long or out of control. Drugs such as nivolumab (anti–PD-1) and ipilimumab (anti-CTLA4) facets of cancer immunotherapy, academic leaders from interfere with that control in a process commonly referred to as http://www.jimmunol.org/ these various disciplines discussed current irAE basic “releasing the brakes” on T cells. Dr. Topalian discussed how and clinical research, irAE diagnosis and management, different immune checkpoint inhibitors have different mecha- and the need for biomarkers and algorithms to identify nisms of action and different frequencies of associated irAEs. individuals at risk for irAEs at a conference jointly spon- Studies of the etiology of irAEs could help elucidate mech- sored by the National Cancer Institute, National Insti- anisms of antitumor activity, as irAE frequency tends to tute of Allergy and Infectious Diseases, and National associate with higher antitumor response. Institute of Arthritis and Musculoskeletal and Skin Dis- As noted by Dr. Bluestone, these irAEs may also provide eases in Bethesda, MD, on March 22–23, 2018. Mech- deeper understanding of the basic immunological mechanisms by guest on September 28, 2021 anisms and models to characterize irAEs, standardize underlying autoimmune conditions. The cross-talk among these protocols, store biospecimens, and capture and analyze specialties has enormous potential for reverse translation in the irAE data were also reviewed during the inaugural fields of cancer, autoimmunity, and immunology. Continued Cancer, Autoimmunity, and Immunology Conference. research into the basic biological responses to immune check- This summary highlights cancer immunotherapy– point inhibitors and other forms of immunotherapy is needed induced irAEs, the challenges ahead, and the oppor- to further define the mechanisms of action, diagnosis, treatment, tunities for greater understanding of autoimmune and management of distinct irAEs that are now being observed conditions. The Journal of Immunology, 2019, 202: in clinical trials and standard oncology practice. 2823–2828. Murine models of irAEs eynote speakers Suzanne Topalian (Johns Hopkins Although human irAEs are not completely reproducible in University) and Jeffrey Bluestone (Parker Institute mice, a number of models have been developed that add to K for Cancer Immunotherapy [PICI] and University our knowledge of immunotherapy-induced irAEs. Keynote of California–San Francisco) introduced each of the morn- speaker Jeffrey Bluestone emphasized that in the future, we ing sessions of the 2-day conference that detailed the biology, should attempt to predict which drug combinations will diagnosis, treatment, management, and the implications of provide robust antitumor effects without irAEs, provided *Department of Critical Care Medicine, Clinical Center, National Institutes of Health, Received for publication March 4, 2019. Accepted for publication March 22, 2019. Bethesda, MD 20892; †ImmunoOncology Branch, Developmental Therapeutics Pro- Address correspondence and reprint requests to Dr. Elad Sharon, National Cancer gram, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National ‡ Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5W512, Institutes of Health, Rockville, MD 20850; Cancer and Inflammation Program, Center Bethesda, MD 20892. E-mail address: [email protected] for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, x MD 21702; Division of Allergy, Immunology, and Transplantation, National Institute Abbreviations used in this article: allo-HSCT, allogeneic hematopoietic stem cell trans- of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852; plantation; FDA, Food and Drug Administration; GVHD, graft-versus-host disease; { Systemic Autoimmune Disease Biology Program, Division of Extramural Research, irAE, immune-related adverse event; NCI, National Cancer Institute; NIAID, National National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insti- Institute of Allergy and Infectious Diseases; PICI, Parker Institute for Cancer ‖ tutes of Health, Bethesda, MD 20892; and Cancer Therapy Evaluation Program, Immunotherapy. Division of Cancer Treatment and Diagnosis, National Cancer Institute, National In- stitutes of Health, Bethesda, MD 20892 ORCIDs: 0000-0002-3118-5111 (H.A.Y.); 0000-0002-0044-9719 (E.S.). www.jimmunol.org/cgi/doi/10.4049/jimmunol.1900264 2824 CANCER, AUTOIMMUNITY, AND IMMUNOLOGY CONFERENCE that well-characterized syngeneic mouse models can be de- of immune-related toxicity in specific organs. In identifying veloped. Further, it will be important for clinicians to choose genetic signatures of immune cells, tumor cells, and stromal the best combination for patients who may be predisposed to cells in the tumor microenvironment, researchers may ef- different subclinical autoimmune conditions and may develop fectively predict responders, nonresponders, and/or patient particular irAEs. Different mouse models with distinct auto- subsets susceptible to irAEs from patient biopsies. One immune tendencies can shed light on these issues. Wild-type approach, as described by both Emanual Maverakis (University mice can also be useful for immunotherapy research, as of California–Davis) and Orit Rozenblatt-Rosen (Broad evidenced by the work of Patrizio Caturegli (Johns Hopkins Institute), involves cross-comparing RNA sequencing data University). His studies in wild-type mice revealed the ex- obtained from tumor samples from patients who have ei- pression of CTLA-4 in the pituitary, which provides the likely ther responded or failed to respond to immune checkpoint mechanistic basis for the hypophysitis that can occasionally blockade with bulk gene expression data from samples develop in patients undergoing anti–CTLA-4 immunotherapy uploaded in The Cancer Genome Atlas. Researchers can (1) (Fig. 1A). Mice with genetic deletion of CTLA-4, PD-1, also compare the gene signatures retrieved from autoimmune and/or PD-L1 have revealed defects in T cell tolerance and and cancer patients. David Hafler (Yale University) provided display various degrees of autoimmunity. As explained by an example of melanoma patients with a BRAFV600K mutation Javid Moslehi (Vanderbilt University), myocarditis occurs that may develop myelin-autoreactive T cells subsequent to 2 2 2 2 2 2 in CTLA-4 / micecrossedwithPD-L1 / or PD-1 / anti–CTLA-4 therapy, similar to T cells found in multiple mice (2), suggesting that combination therapies may increase sclerosis patients (4). Ignacio Sanz (Emory University) indi- Downloaded from the risk for the development of myocardial inflammation cated that next-generation sequencing of TCRs and BCRs, as (Fig. 1B). IFN-g–induced PD-L1 expression on mouse heart well