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Anti-4-1BB agonists are a class of immunotherapy agents designed to stimulate the 4-1BB (CD137) receptor, a potent co-stimulatory molecule expressed on activated T cells and natural killer (NK) cells. By binding to 4-1BB, these agonists enhance T-cell proliferation, survival, and effector functions, thereby boosting the anti-tumor immune response. Early clinical development of first-generation agonists like urelumab was hampered by dose-limiting liver toxicity, leading to the development of second-generation molecules with improved safety profiles, such as utomilumab, or tumor-localized approaches like bispecific antibodies and conditional agonists that activate only in the tumor microenvironment.
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