DOI: 10.1111/imr.12519 INVITED REVIEW LAG3 (CD223) as a cancer immunotherapy target Lawrence P. Andrews1 | Ariel E. Marciscano2 | Charles G. Drake3 | Dario A. A. Vignali1,4 1Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Summary PA, USA Despite the impressive impact of CTLA4 and PD1- PDL1- targeted cancer immuno- 2 Department of Radiation Oncology & therapy, a large proportion of patients with many tumor types fail to respond. Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, The Johns Consequently, the focus has shifted to targeting alternative inhibitory receptors (IRs) Hopkins School of Medicine, Baltimore, MD, and suppressive mechanisms within the tumor microenvironment. Lymphocyte activa- USA tion gene- 3 (LAG3) (CD223) is the third IR to be targeted in the clinic, consequently 3Departments of Oncology, Immunology and Urology, Sidney Kimmel Comprehensive garnering considerable interest and scrutiny. LAG3 upregulation is required to control Cancer Center, The Johns Hopkins School of overt activation and prevent the onset of autoimmunity. However, persistent antigen Medicine, Baltimore, MD, USA 4Tumor Microenvironment Center, University exposure in the tumor microenvironment results in sustained LAG3 expression, con- of Pittsburgh Cancer Institute, Pittsburgh, PA, tributing to a state of exhaustion manifest in impaired proliferation and cytokine pro- USA duction. The exact signaling mechanisms downstream of LAG3 and interplay with Correspondence other IRs remain largely unknown. However, the striking synergy between LAG3 and Dario A. A. Vignali, Department of Immunology, University of Pittsburgh School PD1 observed in multiple settings, coupled with the contrasting intracellular cytoplas- of Medicine, Pittsburgh, PA, USA. mic domain of LAG3 as compared with other IRs, highlights the potential uniqueness Email:
[email protected] Charles G.