Challenges and opportunities in the clinical development of STING agonists for cancer immunotherapy
Author(s)
Motedayen Aval, Leila
Pease, James E
Sharma, Rohini
Pinato, David J
Type
Journal Article
Abstract
Immune checkpoint inhibitors (ICI) have revolutionised cancer therapy. However, they have been effective in only a small subset of patients and a principal mechanism underlying immune-refractoriness is a 'cold' tumour microenvironment, that is, lack of a T-cell-rich, spontaneously inflamed phenotype. As such, there is a demand to develop strategies to transform the tumour milieu of non-responsive patients to one supporting T-cell-based inflammation. The cyclic guanosine monophosphate-adenosine monophosphate synthase-stimulator of interferon genes (cGAS-STING) pathway is a fundamental regulator of innate immune sensing of cancer, with potential to enhance tumour rejection through the induction of a pro-inflammatory response dominated by Type I interferons. Recognition of these positive immune-modulatory properties has rapidly elevated the STING pathway as a putative target for immunotherapy, leading to a myriad of preclinical and clinical studies assessing natural and synthetic cyclic dinucleotides and non-nucleotidyl STING agonists. Despite pre-clinical evidence of efficacy, clinical translation has resulted into disappointingly modest efficacy. Poor pharmacokinetic and physiochemical properties of cyclic dinucleotides are key barriers to the development of STING agonists, most of which require intra-tumoral dosing. Development of systemically administered non-nucleotidyl STING agonists, or conjugation with liposomes, polymers and hydrogels may overcome pharmacokinetic limitations and improve drug delivery. In this review, we summarise the body of evidence supporting a synergistic role of STING agonists with currently approved ICI therapies and discuss whether, despite the numerous obstacles encountered to date, the clinical development of STING agonist as novel anti-cancer therapeutics may still hold the promise of broadening the reach of cancer immunotherapy.
Date Issued
2020-10-16
Date Acceptance
2020-10-12
Citation
Journal of Clinical Medicine, 2020, 9 (10)
ISSN
2077-0383
Publisher
MDPI AG
Journal / Book Title
Journal of Clinical Medicine
Volume
9
Issue
10
Copyright Statement
©2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open accessarticle distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/).
License URL
Sponsor
The Academy of Medical Sciences
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33081170
PII: jcm9103323
Grant Number
N/A
Subjects
STING
STING agonists
cGAS
cyclic dinucleotides (CDNs)
drug delivery systems (DDS)
immune checkpoint inhibitors (ICI)
immune therapy
small molecule agonist
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
ARTN 3323