Immunotherapies have greatly improved the outcomes of many patients with melanoma.

But there is still a need for new approaches for the subset of patients who do not respond well to this type of therapy. 

Moffitt Cancer Center researchers are looking at new targets to help inhibit tumour development and promote anti-tumour immunity, one being the STING inhaling pathway.

In a new article published in Nature Communications, a team of Moffitt and University of Miami Miller School of Medicine investigators demonstrate that targeting the STING pathway with a combination strategy results in improved anti-tumour activity.  

The STING pathway is a key regulator of immune responses to viruses and bacteria and contributes to anti-tumour immunity.

Inhibition of STING signalling is observed in several cancer cell lines, and expression of STING protein decreases as some cancer types progress, such as melanoma.

These observations suggest that agonist drugs, or drugs that activate STING signalling within the tumour environment, may have anti-tumour effects.

“This hypothesis has been confirmed in many pre-clinical laboratory studies. However, STING agonists have had disappointing results in human clinical trials, suggesting that an unknown mechanism is contributing to these poor responses,” said lead study author Rana Falahat, PhD, a research scientist in the immuno-oncology programme at Moffitt. “This is what prompted our study.”

The Moffitt and University of Miami team wanted to improve their understanding of STING signalling and investigate how to improve the anti-tumour activity of STING agonists.

They previously demonstrated that the DNA region that controls STING protein expression is modified by a process called methylation, during which chemical methyl groups are added to the DNA.

This modification reduces the protein level of STING, resulting in less STING protein to inhibit tumour development.

The researchers hypothesised that drugs that block methylation and increase STING expression levels in tumour cells may work in conjunction with STING agonists to kill cancer cells.

The researchers performed experiments in mouse models of melanoma with defective STING signalling either in the tumour cells or the surrounding immune cells.

Similar to the human STING gene, they discovered that the mouse STING gene was also regulated by methylation.

When the researchers treated cells with drugs that blocked methylation, STING expression and signalling increased, leading to the production of chemical messengers that enhanced anti-tumour immunity.

They also demonstrated that treatment of mice with methylation inhibitors and STING agonists resulted in improved antitumour activity that was dependent on the presence and activity of immune cells called CD8 T cells.

These observations reveal that reactivating STING signalling in the tumour cells with methylation inhibitors can shape the therapeutic response to STING agonists.

The researchers hope these preclinical findings will lead to better treatments for cancer patients in the clinic.

“Although additional work will be necessary to further identify optimal dosing levels and therapeutic schedules of each component, insights from our study provide a framework to design proper clinical treatment modalities with appropriate patient selection in melanoma and perhaps other solid tumours,” said James J Mulé, IPhD, senior author, associate center director for Translational Science and the Michael McGillicuddy Endowed Chair for Melanoma Research and Treatment at Moffitt.

Article: Epigenetic state determines the in vivo efficacy of STING agonist therapy

Source: H Lee Moffitt Cancer Center & Research Institute