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LAG-3 Inhibition: Immune Checkpoint Therapy Explained

LAG-3 inhibition is an immuno-oncology approach that blocks the immune checkpoint LAG-3 to restore and enhance the anti-tumor activity of T cells.

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Things worth knowing about "LAG-3 Inhibition"

LAG-3 inhibition is an immuno-oncology approach that blocks the immune checkpoint LAG-3 to restore and enhance the anti-tumor activity of T cells.

What is LAG-3 Inhibition?

LAG-3 inhibition (Lymphocyte Activation Gene-3 inhibition) is a cutting-edge immunotherapeutic strategy in oncology. It involves the use of specific antibodies or other agents to block the surface protein LAG-3, a so-called immune checkpoint — a regulatory protein expressed on the surface of T lymphocytes (immune cells) that dampens the immune response. Cancer cells exploit this mechanism to evade recognition and destruction by the immune system. By inhibiting LAG-3, this brake on immune function is released, allowing T cells to more effectively target and eliminate tumor cells.

Mechanism of Action

LAG-3 (also known as CD223) is a transmembrane protein expressed on activated T cells, natural killer (NK) cells, and regulatory T cells (Tregs). It binds to MHC class II molecules on antigen-presenting cells, as well as to other ligands including FGL1 (Fibrinogen-like Protein 1), LSECtin, and Galectin-3.

When LAG-3 engages its ligands, it suppresses T cell activation and proliferation and promotes T cell exhaustion — a dysfunctional state in which T cells lose their ability to combat tumors effectively. LAG-3 inhibitors block this interaction, reactivate exhausted T cells, and amplify the immune response against the tumor.

Of particular clinical relevance is the combination of LAG-3 inhibitors with PD-1 or PD-L1 inhibitors, as both checkpoint pathways are frequently co-expressed in tumors and their inhibition has synergistic effects on restoring immune function.

Clinical Applications

Currently, the LAG-3 inhibitor relatlimab in combination with the PD-1 inhibitor nivolumab (brand name: Opdualag) has been approved by both the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of unresectable or metastatic melanoma. The pivotal RELATIVITY-047 clinical trial demonstrated that this combination significantly improved progression-free survival compared to nivolumab monotherapy.

Further Indications Under Clinical Investigation

Non-small cell lung cancer (NSCLC)
Hematologic malignancies (e.g., acute myeloid leukemia)
Colorectal cancer
Gastric and esophageal cancer
Other solid tumors with high LAG-3 expression

Side Effects

Like other immune checkpoint inhibitors, LAG-3 inhibition can cause immune-mediated adverse events. These arise because enhanced immune activation may also affect healthy tissue.

Fatigue and general malaise
Skin rash and pruritus (itching)
Elevated liver enzymes (immune-mediated hepatitis)
Thyroid disorders (hypothyroidism, hyperthyroidism)
Lung inflammation (pneumonitis)
Colitis (inflammation of the colon)
Rare but severe endocrine disturbances

The side effect profile is broadly comparable to that of other checkpoint inhibitors and is managed according to severity, typically with corticosteroids or other immunosuppressive therapies.

Relevance in Modern Oncology

LAG-3 inhibition represents the next generation of immune checkpoint therapy. While PD-1/PD-L1 and CTLA-4 inhibitors formed the first wave of checkpoint immunotherapy, LAG-3 inhibitors open new therapeutic avenues — particularly for patients who do not respond to existing checkpoint therapies or who have developed resistance. Numerous ongoing clinical trials are investigating LAG-3 inhibitors both as monotherapy and in combination with other immunotherapeutic or targeted agents.

References

Tawbi H. A. et al. - Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. New England Journal of Medicine, 386(1):24-34 (2022). DOI: 10.1056/NEJMoa2109970
Maruhashi T. et al. - LAG-3: from molecular functions to clinical applications. Journal for ImmunoTherapy of Cancer, 8(2):e001014 (2020). DOI: 10.1136/jitc-2020-001014
European Medicines Agency (EMA) - Opdualag (nivolumab/relatlimab) - European Public Assessment Report (EPAR). Available at: https://www.ema.europa.eu (accessed 2024)

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