Dual-antigen Doggybone DNA vaccine induces potent anti-tumor immunity against immunosuppressive oral cancer

Anti-PD1 blockade benefits only a subset of patients with head and neck squamous cell carcinoma (HNSCC), highlighting the need for approaches that overcome tumor immune resistance. Here, using the doggybone DNA (dbDNATM) platform, we developed CaVac OPT, an optimized dual-antigen DNA vaccine targeting MAGED4B and FJX1, which are overexpressed in most HPV-negative HNSCC and multiple solid tumors. In the MOC-2 oral cancer model, CaVac OPT significantly reduced tumor growth and when combined with anti-PD1 therapy, further delayed progression and improved survival. Immune profiling showed increased infiltration of CD4+ and CD8+ T cells, expansion of stem-like Tcf1+ populations, without increase in regulatory T cells, a reduced M2/M1 macrophage ratio and activation of interferon gamma associated pathways with suppression of tumor-promoting signals. These findings demonstrate that CaVac OPT reprograms the tumor microenvironment, converting cold HNSCC into T cell-inflamed responsive tumors. CaVac OPT represents a promising strategy for achieving durable control of aggressive, immunotherapy-resistant head and neck cancer.