Agents |
These two complementary studies show the utility of Ang-2 inhibition – potentiation of anti-VEGF therapy and extension of the animal survival – irrespective of the mode of VEGF pathway inhibition or the specificity of the inhibitory agents. |
In this study, we used an Angiopoietin-2 neutralizing antibody in combination with the VEGF-TKI cediranib, which also targets other kinases, such as, c-kit, PDGFRβ, and fibroblast growth factor receptor (FGFR)-1. |
In this study, we used a bispecific antibody that neutralizes both VEGF and Angiopoietin-2 (A2V). This particular therapeutic approach is a highly targeted method with limited possibility of interaction with other pathways. |
The results are important for the clinical translation of both approaches (i.e., antibody versus TKI blockade of VEGF pathway), which showed distinct activity in clinical trials in other disease settings. |
GBM models |
The GL261 tumor model was used in both studies because it is a syngeneic tumor model. In this manner, the studies showed comparable effects of the treatments tested. |
In this study, we confirmed the results in the U87 xenograft model, which shows highly abnormal tumor vessels but virtually no invasion. |
In this study, we confirmed the results in the patient-derived cell line MGG8, a “stem cell-like” highly invasive GBM model that displays little vascular abnormality. |
Taken together, the data from these two studies address the key issue of GBM heterogeneity, by covering a broad spectrum of malignant behavior and vascular pathophysiology in GBMs. |
Immunological studies |
The two approaches of dual VEGF/Ang-2 targeting confirmed the change in the tumor-associated macrophage (TAM) phenotype along the M1-M2 continuum. |
The anti-Ang2/VEGFR TKI combination therapy led to a change in TAM phenotype. |
Bispecific antibody A2V reprograms TAMs clearly polarized toward the anti-tumor phenotype, and decreases M2 macrophages thereby alleviating immunosuppression. Also, this study shows that these effects extend to resident microglia. |
Irrespective of the approach to dual VEGF/Ang-2 inhibition, this therapy can alter the phenotype of TAMs along the M1-M2 continuum. Taken together, the results from these studies reveal the range of TAM and microglia polarization in GBM.
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This study demonstrates the causal role of TAMs in achieving a survival benefit of dual therapy. Using a CSF1 neutralizing Ab to block TAM infiltration, we show that dual therapy looses its efficacy against GBM. |
This study demonstrates that achieving a survival benefit is independent of T cells by analyzing and depleting T cell population. |
The two studies distinctly define two separate and complementary mechanisms involving anti-tumor immunity imparted by dual inhibition of VEGF and Ang-2 in GBM. |