Immunotherapy has shown effectiveness against experimental malignant brain tumors, but the clinical results have been less convincing most likely due to immunosuppression. Prostaglandin E 2 (PGE 2 ) is the key immunosuppressive product of cyclooxygenase-2 (COX-2) and increased levels of PGE 2 and COX-2 have been shown in several tumor types, including brain tumors. In the current study, we report enhanced cure rate of mice with established mouse GL261 brain tumors when immunized with granulocyte macrophage-colony stimulating factor (GM-CSF) secreting tumor cells and simultaneously treated with the selective COX-2 inhibitors parecoxib systemically (5 mg/kg/day; 69% cure rate) or valdecoxib intratumorally (5.3 mg/kg/day; 63% cure rate). Both combined therapies induced a systemic antitumor response of proliferating CD4 1 and CD8 1 T cells, and further analysis revealed T helper 1 (T h 1) cell supremacy. The GL261 tumor cell line produced low levels of PGE 2 in vitro, and co-staining at the tumor site demonstrated that a large fraction of the COX-2 1 cells were derived from CD45 1 immune cells and more specifically macrophages (F4/80 1 ), indicating that tumor-infiltrating immune cells constitute the primary source of COX-2 and PGE 2 in this model. We conclude that intratumoral COX-2 inhibition potentiates GM-CSF immunotherapy against established brain tumors at substantially lower doses than systemic administration. These findings underscore the central role of targeting COX-2 during immunotherapy and implicate intratumoral COX-2 as the primary target.The prognosis for patients with high-grade brain tumors remains poor despite extensive treatment, including surgery, radiotherapy and chemotherapy. 1,2 Treatment failure is mainly ascribed to the infiltrative capacity of the tumor cells, which form tumor microsatellites deep in the normal brain parenchyma. Immunotherapy represents a novel approach that could target these residual tumor cells and has been shown to be safe and induce prolonged survival in clinical trials. [3][4][5] However, the therapeutic effect of immunotherapy is often down-regulated because of immunosuppression.Prostaglandin E 2 (PGE 2 ) constitutes a key suppressive mediator and is synthesized from arachidonic acid by cyclooxygenases (COX) and prostaglandin synthases. The inducible COX-2 and the downstream microsomal prostaglandin E synthase-1 (mPGES-1) are overexpressed in a wide range of tumors, including high-grade brain tumors, and most reports show correlations with poor prognosis, although adverse results are reported. 6-8 PGE 2 has been alleged to exert immunosuppression by either direct effects on T cells by stimulating T h 2 cytokines as interleukin-10 (IL-10) and simultaneously inhibiting T h 1 cytokines as interferon-g (IFN-g) or by indirect effects via promotion of myeloid-derived suppressor cells (MDSCs) and regulatory T (T reg ) cells, which in turn induce T cell tolerance. [9][10][11][12] We and others have shown that peripheral immunotherapy using granulocyte macrophage-colony stimu...