Effective PD-1 Checkpoint Blockade in Bladder Cancer Model Requires Tumor-Draining Lymph Nodes and Lymphocyte Trafficking.

INTRODUCTION:Tumor-draining lymph nodes (tdLNs) are key hubs for antitumor T-cell priming. However, their contribution to PD-1 checkpoint blockade in bladder cancer remains poorly defined. In this study, we investigated whether tdLNs and lymphocyte trafficking are required for effective anti-PD-1 therapy in an orthotopic preclinical model of bladder cancer. METHODS:We used C57BL/6 mice bearing intravesical MB49-luciferase tumors. Lymphocyte trafficking was blocked pharmacologically using the sphingosine-1-phosphate receptor modulator FTY720, or surgically by iliac/obturator and lumbar lymphadenectomy prior to anti-PD-1 antibody administration. Tumor burden, survival, and immune cell phenotypes were assessed by flow cytometry. Lymphatic drainage of the bladder was mapped by intravesical Evans Blue dye. RESULTS:Anti-PD-1 monotherapy significantly improved survival (P = 0.0019) and reduced tumor weight (P = 0.019) and (P = 0.0029), effects that were abrogated with FTY720 or tdLN removal. Anti-PD-1 increased intratumoral CD8⁺ effector, proliferating (Ki67⁺), and stem-like (PD-1⁺ TCF1⁺) T cells, as well as CD40high cDC1 dendritic cells, consistent with enhanced cross-priming. Evans Blue tracing confirmed iliac and lumbar nodes as the dominant tdLNs. Study limitations include the restricted lymphatic architecture in mice compared to humans, which may underestimate redundancy in human tdLN networks. CONCLUSIONS:Effective PD-1 blockade in bladder cancer significantly depends on intact tdLNs and active lymphocyte trafficking. Preserving nodal integrity may optimize immunotherapy responses, supporting the rationale the rationale for neoadjuvant PD-1 blockade prior surgical disruption of lymphatic channels.