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Cavrotolimod + pembrolizumab is a combination immunotherapy regimen studied for advanced or metastatic cancers refractory to PD-1 blockade. Cavrotolimod is a synthetic spherical nucleic acid-based Toll-like receptor 9 (TLR9) agonist designed to stimulate innate immunity through TLR9, leading to activation of dendritic cells, NK cells, and T cells, and the induction of various cytokines and chemokines. Pembrolizumab is a monoclonal antibody targeting programmed cell death protein 1 (PD-1), blocking its interaction with PD-L1 and PD-L2, thereby releasing the “brakes” on T cells and enhancing antitumor immune responses. The combination was developed to enhance the efficacy of checkpoint inhibitors by increasing tumor immunogenicity and sustaining the cancer immunity cycle. Several trials have focused on advanced solid tumors, particularly skin cancers such as melanoma, Merkel cell carcinoma, and cutaneous squamous cell carcinoma that have proved refractory to prior immune checkpoint blockade[1][2][3][4].
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