Tumor-associated macrophages (TAMs) are present within the stroma of most solid tumors where they contribute to disease progression through production of tumor and angiogenic growth factors, extracellular matrix remodeling, and suppression of immune responses. As such, depletion of tumor-associated macrophages, for instance through the use of blocking antibodies against the CSF-1 receptor (CSF1R), has been widely explored as a therapeutic approach to both inhibit tumor growth/metastasis and stimulate antitumor immune responses. In the context of immunotherapy, multiple preclinical murine studies have demonstrated that anti-CSF1R meditated macrophage depletion can promote antitumor T-cell responses, synergizing with immune checkpoint inhibitor therapy, such as PD1 blockade, and leading to tumor regression. However, some tumor models appear resistant to these beneficial effects of CSF1R blockade. In order to define potential mechanisms of resistance to CSF1R inhibitors, we evaluated the effects of anti-CSF1R treatment in mice bearing subcutaneous Renca renal cell adenocarcinoma tumors. Despite robust macrophage depletion, this model shows only a modest decrease in tumor volume and minimal effector T-cell recruitment or activation in response to anti-CSF1R therapy. Comprehensive flow cytometry-based immunophenotyping and single-cell RNA sequencing on immune cells isolated from anti-CSF1R- and isotype control-treated Renca tumors revealed shifts in gene expression patterns related to vascular remodeling, hypoxic responses, and enhanced regulatory T-cell activity. These studies indicate macrophage depletion may, under some conditions, have negative effects on antitumor immune responses that could limit the clinical benefit of this therapeutic approach.

Citation Format: Katarzyna M. Skrzypczynska, Sarah A. O'Brien, Brian Belmontes, Hong Tan, Jessica Orf, Daniel Lu, Ian Driver, Jackson G. Egen. Resistance mechanisms limiting the immunostimulatory and antitumor activity of anti-CSF-1 receptor-mediated macrophage depletion [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr A71.