PD-L1 checkpoint blockade promotes regulatory T cell activity that underlies therapy resistance

Despite the clinical success of immune checkpoint blockade (ICB), in certain cancer types, most patients with cancer do not respond well. Furthermore, in patients for whom ICB is initially successful, this is often short-lived because of the development of resistance to ICB. The mechanisms underlying primary or secondary ICB resistance are incompletely understood. Here, we identified preferential activation and enhanced suppressive capacity of regulatory T cells (T-reg cells) in aPD-L1 therapy-resistant solid tumor-bearing mice. T-reg cell depletion reversed resistance to aPD-L1 with concomitant expansion of effector T cells. Moreover, we found that tumor-infiltrating T-reg cells in human patients with skin cancer, and in patients with non-small cell lung cancer, up-regulated a suppressive transcriptional gene program after ICB treatment, which correlated with lack of treatment response. aPD-1/PD-L1-induced PD-1(+) T-reg cell activation was also seen in peripheral blood of patients with lung cancer and mesothelioma, especially in nonresponders. Together, these data reveal that treatment with aPD-1 and aPD-L1 unleashes the immunosuppressive role of T-reg cells, resulting in therapy resistance, suggesting that T-reg cell targeting is an important adjunct strategy to enhance therapeutic efficacy.