Purpose: Adaptive antitumor immunity following ablative radiotherapy (ART) is attenuated by host myeloid-derived suppressor cell (MDSC), tumor-associated macrophage (TAM), and regulatory T-cell (Treg) infiltrates. We hypothesized treatment with ART and a secondary mitochondrialderived activators of caspase (SMAC) mimetic could reverse the immunosuppressive lung cancer microenvironment to favor adaptive immunity.Experimental Design: To evaluate for synergy between ART and the SMAC mimetic Debio 1143 and the dependence upon CD8 þ T cells and TNFa, we used LLC-OVA syngeneic mouse model of lung cancer and treated them with Debio 1143 and/or ART (30 Gy) with or without anti-CD8, anti-TNFa, or anti-IFNg antibodies. Tumorinfiltrating OVA-specific CD8 þ T cells, Tc1 effector cells, MDSCs, TAMs, and Tregs, were quantified by flow cytometry. Tc1-promoting cytokines TNFa, IFNg, and IL1b and the immunosuppressive IL10 and Arg-1 within LLC-OVA tumor tissue or mouse serum were measured by RT-PCR and ELISA.Results: ART delayed tumor growth, and the addition of Debio 1143 greatly enhanced its efficacy, which included several complete responses. These complete responders rejected an LLC-OVA tumor rechallenge. ART and Debio 1143 synergistically induced a tumor-specific, Tc1 cellular and cytokine response while eliminating immunosuppressive cells and cytokines from the tumor microenvironment. Depletion of CD8 þ cells, TNFa, and IFNg with blocking antibody abrogated synergy between ART and Debio 1143 and partially restored tumor-infiltrating MDSCs.Conclusions: Debio 1143 augments the tumor-specific adaptive immunity induced by ART, while reversing host immunosuppressive cell infiltrates in the tumor microenvironment in a TNFa, IFNg, and CD8 þ T-cell-dependent manner. This provides a novel strategy to enhance the immunogenicity of ART. The combination of ART and Debio 1143 reduces immunosuppressive cell populations and produces an OVA-specific cytotoxic T-cell response in the tumor microenvironment. A, CD8 þ T lymphocytes primed with OVA-tetramer were quantified in LLC-OVA tumors using flow cytometry, and are expressed as a percentage of CD8 þ cells. IFNg (B) and TNFa (C) expression among OVA þ CD8 þ lymphocytes was determined by flow cytometry. These cells are expressed as a percentage of CD8 þ cells. D, Tumors were analyzed for the MDSC markers CD45/Gr1/CD11b using flow cytometry. CD11b þ Gr-1 þ cells are expressed as a percentage of CD45 þ cells. E, LLC-OVA tumors were assessed for the TAM markers CD45/F4/80/CD11b by flow cytometry. The percentage of TAMs is expressed as a percentage of CD45 þ cells. F, LLC-OVA tumors were assessed for the Treg markers CD4/FOXP3/CD25 by flow cytometry. Tregs are expressed as a percentage of CD4 þ cells. All plots show a representative sample (left) and are expressed as a mean with 5 plotted replicates (right). Statistical differences were assessed using the unpaired Student t test. P values are indicated as follows: Ã , P < 0.05; ÃÃ , P < 0.01; ÃÃÃ , P < 0.001.