Review Article

Combinatorial Approach to Improve Cancer Immunotherapy: Rational Drug Design Strategy to Simultaneously Hit Multiple Targets to Kill Tumor Cells and to Activate the Immune System

Table 1

Clinical studies of combination strategies to improve immunotherapy.

Combinatorial approachCombination Therapy & Drug UsedCancer Vaccine or Immunotherapy
Drug Used
Tumor Type & Reference

Strategies to increase tumor immunogenicityChemotherapyCyclophosphamideFive peptide cancer vaccinePhase I clinical trial in advanced solid tumors (NCT00676949) [12]
PembrolizumabAdvanced sarcomas and gastrointestinal tumors 
(NCT02406781) [13]
GemcitabineGV1001 vaccine given with GMCSF adjuvantIn Phase 3 Telo-Vac clinical study in pancreatic cancer [14].
Anti-CD40 antibody APX005M or with nivolumabPhase I and II clinical trial for pancreatic patients (NCT03214250) [15]
IpilimumabPhase I clinical trial for Pancreatic Cancer (NCT01473940)
Melphalan and DactinomycinIpilimumabPhase 2 trial in advanced melanoma (NCT01323517)
DacarbazineIpilimumabPhase 3 clinical trial in advanced melanoma (NCT00324155) [16]
Paclitaxel and CarboplatinIpilimumabPhase 2 clinical trial for non–small cell lung cancer (NSCLC) (NCT00527735) and small-cell lung cancer (NCT 00527735) [17, 18]
Paclitaxel, Carboplatin and 
Premetrexed
PembrolizumabPhase 2 clinical trial for lung cancer (NCT02039674)
Paclitaxel, Carboplatin, gemcitabineNivolumabPhase I clinical trial for 
Pancreatic, breast, NSCLC (NCT02309177)
RadiotherapyStereotactic body radiationIpilimumabMelanoma (NCT01970527), prostrate (NCT00323882) and lung cancer (NCT02239900).
High dose IL-2Kidney and skin cancer (NCT01896271) [19]
Pembrolizumab and nivolumabPhase I and II clinical trials of radiation with in NSCLC (NCT3148327) [20]
NivolumabGlioblastoma (NCT02617589), triple negative 
breast cancer (NCT02499367)
Pembrolizumabmetastatic Head and neck squamous carcinoma (NCT03386357)
Durvalumab and tremelimumabLocally advanced Head and neck squamous carcinoma NCT03426657
Epigenetic TherapySGI-110 
(DNMT inhibitor)
IpilimumabMelanoma (NCT02608437)
Vorinostat (HDAC inhibitor)PembrolizumabRenal cell carcinoma 
(NCT02619253)
Entinostat (HDAC inhibitor)PembrolizumabMelanoma and NSCLC 
(NCT02437136)
Azacitidine (DNMT inhibitor) + 
entinostat
NivolumabNSCLC (NCT01928576)

Strategies to reverse tumor immunosuppressionMacrophage Targeted Therapy
Blocking recruitment of macrophages
Carlumab 
(human anti-CCL2 IgG1κ mAb (CNTO 888)
Prostrate cancer [21] and 
advanced cancer patients [22]
PF-04136309 
(CCL2-CCR2 axis inhibitor)
PF-04136309 plus FOLFIRINOX show better treatment response in patients with locally advance PDAC (NCT01413022)
Reduction of TAMs by depleting TAMs or its precursorRG7155 (anti-CSF1R neutralizing antibodies) RG7155 demonstrated therapeutic efficacy in patients with diffuse-type giant cell tumor
Plexiform Neurofibromas, 
Neurofibromatosis 
(NCT02390752)
PLX3397 (pexidartinib) (CSF-1R inhibitor) UrvalumabAdvanced Pancreatic and colorectal cancer 
(NCT02777710)
PembrolizumabMelanoma and solid tumors (NCT02452424)
BLZ945 (CSFIR inhibitor)PDR001 
(anti-PD1)
Phase I/II clinical trial in advanced solid tumors (NCT02829723)
TrabectedinPhase III study showed trabectedin plus PLD improves overall survival than PLD alone in ovarian cancer 
Phase III trial in locally advanced or metastatic liposarcoma (NCT01692678)
Reprogramming of macrophages into anti-tumor phenotypeIPI-549PembrolizumabSolid tumors 
(NCT02637531)
RO7009789 
(Agonist CD40 Ab)
Nab-paclitaxel and gemcitabinePancreatic adenocarcinoma 
(NCT02588443)
AtezolizumabMetastatic solid tumors 
(NCT02304393)
TLR agonistsDV821  (TLR9 agonist)Anti-PD1 abPhase I NSCLC 
NCT03326752
Poly-IC-LC (TLR3)PembrolizumabColon cancer 
(NCT02834052)
MDSC Targeted therapy
Reduction in accumulation of MDSCs
ATRAIpilimumabStage IV melanoma 
(NCT02403778)
Bevacizumab, entinostatAtezolizumabAdvanced renal cell carcinoma (NCT03024437)
Blockade or recruitment of MDSCsSX-682PembrolizumabMelanoma 
(NCT03161431)
RTA-408Ipilimumab 
Nivolumab
Melanoma 
(NCT02259231)
Treg targeted therapyCCR4 inhibitorPembrolizumabPhase 1 and 2 for solid tumors (NCT02178722)
Epacadostat (IDO inhibitor)DurvalumabAdvanced solid tumors 
(NCT02318277)
AtezolizumabNSCLC 
(NCT02298153)
galunisertib 
(TGF beta inhibitor)
Durvalumab or nivolumabPancreatic cancer 
(NCT02423343).

Strategies to design and synthesize novel dual or triple inhibitory chemotypes that can block multiple pathwaysSF1126Solid tumors (NCT00907205)
Recurrent or progressive SCCHN tumors (NCT02644122)
Neuroblastoma 
(NCT02337309)
NivolumabHepatocellular carcinoma (NCT03059147)