Combination of exosome vaccines, lenvatinib, and anti-PD-1 eradicates tumor in autochthonous hepatocellular carcinoma mice.

Zuo, Bingfeng; Liu, Xuening; Zhang, Zheng; Xu, Zhenqiang; Zhong, Yanzhi; Zhang, Yang; Yang, Qian; Yu, Zezhen et al. · Cell Rep Med · 2026

basic_science · Level V

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Abstract

Unresectable hepatocellular carcinoma (HCC) demands more effective therapeutics to overcome its dismal prognosis. Dendritic cell (DC)-derived exosomes (DEXs) modified with CP05-anchored HCC-targeting peptide (P47-P), DC-recruiting and -activating high-mobility group nucleosome-binding protein 1 (HMGN1) (N1ND-N), and lymphotactin domains (XCL1-X) make DEX<sub>PNX</sub>. In situ antigen release by oral lenvatinib (LEN) with intravenous DEX<sub>PNX</sub> (DEX<sub>PNX</sub>/LEN) synergistically promotes intratumoral DC recruitment and activation. This enhances tumor neoantigen cross-presentation, de novo T cell responses, and durable immunological memory against rechallenge in orthotopic HCC mice. Furthermore, DEX<sub>PNX</sub>/LEN suppresses tumor growth and increases tumor-infiltrating CD8<sup>+</sup> T cells in diethyl-nitrosamine (DENA)-induced and non-alcoholic steatohepatitis-associated HCC mice. Crucially, combining DEX<sub>PNX</sub>/LEN with anti-PD-1 eradicates established tumor and boosts intratumoral CD8<sup>+</sup> effector T cell expansion in autochthonous HCC mice. Our study demonstrates a generalizable strategy to elicit personalized antitumor responses by leveraging DEX vaccines to activate tumoral DCs against LEN-released antigens, strengthened by anti-PD-1 blocking T cell exhaustion. This represents a clinically viable approach to improve HCC outcomes.