T cells play a critical role in the control of cancer. The development of immune checkpoint blockers (ICB) aimed at enhancing anti-tumor T cell responses has revolutionized cancer treatment. However, durable clinical benefit is observed in only a subset of patients, prompting research efforts to focus on strategies that target multiple inhibitory signals within the tumor microenvironment (TME) to limit tumor evasion and improve patient outcomes. Adenosine has emerged as a potent immune suppressant within the TME and CD73 is the major enzyme responsible for its extracellular production. CD73 can be co-opted within the TME to impair T cell-mediated anti-tumor immunity and promote tumor growth. To target this pathway and block the formation of adenosine, we designed a novel, selective and potent class of small-molecule inhibitors of CD73, including AB680 (quemliclustat), which is currently being tested in cancer patients. AB680 effectively restored T cell proliferation, cytokine secretion and cytotoxicity that were dampened by the formation of immunosuppressive adenosine by CD73. Furthermore, in an allogeneic mixed lymphocyte reaction where CD73-derived adenosine had a dominant suppressive effect in the presence of PD-1 blockade, AB680 restored T cell activation and function. Finally, in a preclinical mouse model of melanoma, AB680 inhibited CD73 in the TME and increased the anti-tumor activity of PD-1 blockade. Collectively, these data provide a rationale for the inhibition of CD73 with AB680 in combination with ICB, such as anti-PD-1, to improve cancer patient outcomes.

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