Targeted Alpha-Particle Radiotherapy And Immune Checkpoint Inhibitors Induces Cooperative Inhibition On Tumor Growth Of Malignant Melanoma

Simple Summary Radiation therapy and immune checkpoint inhibitors (ICIs) have been demonstrated to cooperatively activate adaptive anti-tumor immunity with curative potential in preclinical models of melanoma. Receptor-targeted radionuclide therapy can be systemically injected to selectively deliver ionizing radiation to tumor sites throughout the body, potentially rendering all tumor sites more susceptible to anti-tumor immune response. In this study, we demonstrated the feasibility of delivering alpha-particle radiation to murine melanoma tumors using a Pb-212 radiolabeled peptide [Pb-212]VMT01 that targets the melanocortin 1 receptor (MC1R). Our data showed anti-tumor cooperation between [Pb-212]VMT01 and ICIs in melanoma, mediated by induction of tumor-specific immunity. The immunogenicity of [Pb-212]VMT01 in melanoma was also evidenced by enhanced tumor infiltrating lymphocytes and tumor vaccination assays. Radiotherapy can facilitate the immune recognition of immunologically "cold" tumors and enhance the efficacy of anti-PD-1 and anti-CTLA-4 immune checkpoint inhibitors (ICIs) in melanoma. Systemic administration of receptor-targeted radionuclide therapy has the potential to selectively deliver radionuclides to multiple tumors throughout the body in metastatic settings. By triggering immunologic cell death and increasing the immune susceptibility of surviving tumor cells in these locations, targeted radionuclide therapies may overcome resistance to ICIs and render immunologically "cold" tumors throughout the body responsive to ICIs and immunologically "hot". Here, we show the anti-tumor cooperation of targeted alpha-particle radionuclide therapy (alpha-TRT) and ICIs in preclinical models of melanoma. Melanocortin 1 receptor (MC1R)-targeted radiopeptide [Pb-212]VMT01 was employed to deliver alpha-radiation to melanoma tumors in mice. A single injection of 4.1 MBq [Pb-212]VMT01 significantly slowed the tumor growth of B16-F10 melanoma and the combination of [Pb-212]VMT01 and ICIs induced a cooperative anti-tumor effect leading to 43% complete tumor response with no sign of malignancy on autopsy. Animals with complete response developed anti-tumor immunity to reject further tumor inoculations. This therapeutic cooperation was completely abolished in RAG1 KO mice, which are deficient in T-cell maturation. In addition, the anti-tumor cooperation was compromised when fractionated [Pb-212]VMT01 was used in the combination. We also demonstrated that [Pb-212]VMT01 induced immunogenic cell death in tumor vaccination assays and in vitro exposure to [Pb-212]VMT01 sensitized immunotolerant melanoma to ICIs treatment in vivo. Enhanced tumor infiltrating CD3(+), CD4(+), CD8(+) lymphocytes were observed following injection of 1.4 MBq [Pb-212]VMT01. Overall, we demonstrated anti-tumor cooperation between alpha-TRT and ICIs in melanoma that is mediated by tumor specific immunity.