# Induction of Senescence using Dexamethasone to re-sensitize NSCLC to anti-PD1 therapy

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

Lung cancer accounts for 30% of all cancers among American war Veterans, and remains the leading
cause of cancer related deaths. Half of all lung cancers are metastatic non-small cell lung cancer (NSCLC),
with a 2-year survival rate of 10%. Immunotherapy with immune checkpoint inhibitors (ICI) has emerged as a
promising therapeutic strategy that aims to harness the immune system to fight lung cancer. However, given
the modest response rates of 20-25%% to these ICIs and the desire to extend their benefits to more patients,
there is a critical need for the development of novel approaches that can expand the benefit from ICIs and
create more durable responses, prolonging survival from lung cancer.
 Our studies show that extended dexamethasone (Dex) treatment induces irreversible cell cycle
blockade and a senescence phenotype through chronic activation of the p27Kip1 gene in glucocorticoid receptor
(GR) overexpressing lung adenocarcinoma cell populations. Further, following withdrawal of Dex, proteins
associated with the senescence associated secretory phenotype (SASP), particularly CCL2, CCL4, CXCL1
and CXCL2 strongly attracted and expanded T-cells, NK cells and monocytes and stimulated tumor cell
cytolytic activity of NK cells. Our overarching hypothesis is that in lung AC patients who are not on baseline
steroids, pre-treatment with Dex will induce a persistent senescence phenotype in tumor cell sub-populations
expressing moderate/high levels of GRα and resultant chemokines produced by the senescent cells will
mobilize host immune cells to reboot response to ICI following complete Dex withdrawal. We will test this
hypothesis through the conduct of the following aims.
Specific Aim 1: Use FLT-PET imaging and blood analysis to test whether a 7-14 day pre-treatment of
lung AC patients with Dex followed by Dex withdrawal will induce persistent senescence related cell
cycle arrest in ≥ 1 lesion in ≥ 60% of patients, (based on GRα expression) accompanied by release of
SASP proteins and activation of T and NK cells.
Specific Aim 2: Test whether a 7-14 day pre-treatment of lung AC patients with Dex followed by Dex
withdrawal and subsequent re-challenge with pembrolizumab will yield an overall response rate (ORR)
of ≥ 33% to pembrolizumab in association with tumor GR status, SASP and immune cell activation.
 These aims will be conducted through a Phase II clinical trial designed as a single-arm two-stage study
in Veterans whose lung AC has progressed on ICI. Based on our preliminary data, we expect that Dex will
induce tumor senescence in at least one lesion in ≥ 60% of patients and secondarily improve overall response
to pembrolizumab by 33%. Success with these aims would inform a larger study that could potentially change
the way we approach patients with primary or acquired resistance to ICIs with an off the shelf medication that
could re-sensitize lung AC to ICIs. Our proposed research could substantially benefit Veterans with metastatic
NSCLC, a group ...

## Key facts

- **NIH application ID:** 10425223
- **Project number:** 5I01CX002007-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** NITHYA RAMNATH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10425223

## Citation

> US National Institutes of Health, RePORTER application 10425223, Induction of Senescence using Dexamethasone to re-sensitize NSCLC to anti-PD1 therapy (5I01CX002007-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10425223. Licensed CC0.

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