PurposeThis paper aims to describe how a patient centred recovery approach was implemented in a secure learning disabilities service.Design/methodology/approachThere are no specific tools for measuring recovery in a secure learning disabilities service. The Recovery Star; a measure of individual recovery was adopted for use among the patients. Staff underwent training on the use of the Recovery Star tool after which a multidisciplinary steering group made some modifications to the tool. Training was cascaded to staff throughout the service and use of the Recovery Star tool was embedded in the care programme approach process.FindingsIt was found that implementing a recovery approach with the Recovery Star tool was a beneficial process for the service but that services will require a whole systems approach to implementing recovery. Key workers working with patients thought that the structure of the Recovery Star tool opened up avenues for discussing topics covered in the domains of the Recovery Star tool which may otherwise have not been discussed as fully.Practical implicationsThe availability of a tool, integrated into existing service processes, e.g. care programme approach and accompanied by a systems approach, equips patients and staff for articulating and measuring the recovery journey.Originality/valueThe paper shows that the Recovery Star tool, embedded in a care programme approach process, equips patients and staff for measuring the recovery journey.

Tumor necrosis factor receptor 2 (TNFR2) is central to immune balance control in humans and mice. We created human-directed anti-TNFR2 antibodies as a therapeutic approach in cancer, with positive findings (Torrey H, et al. Sci Signal 2017). We have also identified a murine-directed surrogate antagonistic antibody to TNFR2. This antibody shares traits identified in our human-directed antibodies as critical to limiting regulatory T cell (Treg) expansion and activating T effector (Teff) cells. We now present data on this surrogate anti-TNFR2 antibody in two syngeneic mouse models of colon cancer. To study the therapeutic effects of solo and combined immunotherapy using the murine-directed anti-TNFR2 antibody, we used CT26 and MC38 colon tumor models to compare: (i) the murine-directed surrogate anti-TNFR2 antibody therapy, (ii) a commercially available anti-PD1 therapy, and (iii) anti-TNFR2/anti-PD1 combination immunotherapy. Mice were dosed bi-weekly (100ug/mouse antibody). Antigen-specific CD8 and Treg infiltrates were also studied. Mice were tested and monitored for tumor growth by either Champions Oncology (Hackensack, NJ) or a third-party pharmaceutical company in accordance with their respective animal welfare guidelines. In the CT26 model, anti-TNFR2 antagonism alone or cotreatment with anti-PD1 and anti-TNFR2 was highly efficacious (55-62% of mice cured). Anti-PD1 alone was less efficacious (25% cured). In the MC38 model, therapy with anti-TNFR2 alone showed some efficacy (20% cured), anti-PD1 alone had the least efficacy (10% cured), and anti-PD1 in combination with anti-TNFR2 yielded the best overall survival (70% cured). Sequential antibody dosing with anti-PD1 followed by anti-TNFR2 showed no synergy. In contrast, sequential treatment with anti-TNFR2 first followed by anti-PD1, or the combination of anti-TNFR2 plus anti-PD1, showed synergy and highest efficacy. Anti-TNFR2 therapy was distinct from anti-PD1 in showing pronounced Treg depletion and enhanced Teff infiltration in the tumor microenvironment, demonstrating in vivo specificity for disease-causing cells only in the tumor. Anti-TNFR2 immunotherapy provides benefits in two colon cancer models, both as a single agent and when administered in combination with anti-PD1. Anti-PD1 before anti-TNFR2 was associated with poor outcomes for survival, histology, and lack of long-term cure, suggesting that nonspecific unleashing of the immune system with anti-PD1 destroys the tumor microenvironment specificity of anti-TNFR2. These results highlight the value of anti-TNFR2 antagonism in vivo in mouse tumor models as solo therapy or as a combination therapy, administered first or concurrently with anti-PD1. This study of new immunotherapy combinations highlights the need to test both single-agent therapy and sequential combination therapy as new agents are brought forward to the clinic. Citation Format: Russell LaMontagne, Katie Case, Lisa Tran, Hui Zheng, Michael Yang, Denise Faustman. TNFR2 blockade alone or in combination with PD-1 blockade shows therapeutic efficacy in murine cancer models [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B77.