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Topical TLR7 agonist imiquimod can induce immune-mediated rejection of skin metastases in patients with breast cancer.


ABSTRACT: Skin metastases of breast cancer remain a therapeutic challenge. Toll-like receptor 7 agonist imiquimod is an immune response modifier and can induce immune-mediated rejection of primary skin malignancies when topically applied. Here we tested the hypothesis that topical imiquimod stimulates local antitumor immunity and induces the regression of breast cancer skin metastases.A prospective clinical trial was designed to evaluate the local tumor response rate of breast cancer skin metastases treated with topical imiquimod, applied 5 d/wk for 8 weeks. Safety and immunologic correlates were secondary objectives.Ten patients were enrolled and completed the study. Imiquimod treatment was well tolerated, with only grade 1 to 2 transient local and systemic side effects consistent with imiquimod's immunomodulatory effects. Two patients achieved a partial response [20%; 95% confidence interval (CI), 3%-56%]. Responders showed histologic tumor regression with evidence of an immune-mediated response, showed by changes in the tumor lymphocytic infiltrate and locally produced cytokines.Topical imiquimod is a beneficial treatment modality for breast cancer metastatic to skin/chest wall and is well tolerated. Importantly, imiquimod can promote a proimmunogenic tumor microenvironment in breast cancer. Preclinical data generated by our group suggest superior results with a combination of imiquimod and ionizing radiation and we are currently testing in patients whether the combination can further improve antitumor immune and clinical responses.

SUBMITTER: Adams S 

PROVIDER: S-EPMC3580198 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Topical TLR7 agonist imiquimod can induce immune-mediated rejection of skin metastases in patients with breast cancer.

Adams Sylvia S   Kozhaya Lina L   Martiniuk Frank F   Meng Tze-Chiang TC   Chiriboga Luis L   Liebes Leonard L   Hochman Tsivia T   Shuman Nicholas N   Axelrod Deborah D   Speyer James J   Novik Yelena Y   Tiersten Amy A   Goldberg Judith D JD   Formenti Silvia C SC   Bhardwaj Nina N   Unutmaz Derya D   Demaria Sandra S  

Clinical cancer research : an official journal of the American Association for Cancer Research 20120705 24


<h4>Purpose</h4>Skin metastases of breast cancer remain a therapeutic challenge. Toll-like receptor 7 agonist imiquimod is an immune response modifier and can induce immune-mediated rejection of primary skin malignancies when topically applied. Here we tested the hypothesis that topical imiquimod stimulates local antitumor immunity and induces the regression of breast cancer skin metastases.<h4>Experimental design</h4>A prospective clinical trial was designed to evaluate the local tumor response  ...[more]

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