3501
|
Long KB, Young RM, Boesteanu AC, Davis MM, Melenhorst JJ, Lacey SF, DeGaramo DA, Levine BL, Fraietta JA. CAR T Cell Therapy of Non-hematopoietic Malignancies: Detours on the Road to Clinical Success. Front Immunol 2018; 9:2740. [PMID: 30559740 PMCID: PMC6287001 DOI: 10.3389/fimmu.2018.02740] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022] Open
Abstract
Chimeric antigen receptor (CAR)-engineered T cells represent a breakthrough in personalized medicine. In this strategy, a patient's own T lymphocytes are genetically reprogrammed to encode a synthetic receptor that binds a tumor antigen, allowing T cells to recognize and kill antigen-expressing cancer cells. As a result of complete and durable responses in individuals who are refractory to standard of care therapy, CAR T cells directed against the CD19 protein have been granted United States Food and Drug Administration (FDA) approval as a therapy for treatment of pediatric and young adult acute lymphoblastic leukemia and diffuse large B cell lymphoma. Human trials of CAR T cells targeting CD19 or B cell maturation antigen in multiple myeloma have also reported early successes. However, a clear and consistently reproducible demonstration of the clinical efficacy of CAR T cells in the setting of solid tumors has not been reported to date. Here, we review the history and status of CAR T cell therapy for solid tumors, potential T cell-intrinsic determinants of response and resistance as well as extrinsic obstacles to the success of this approach for much more prevalent non-hematopoietic malignancies. In addition, we summarize recent strategies and innovations that aim to augment the potency of CAR T cells in the face of multiple immunosuppressive barriers operative within the solid tumor microenvironment. Advances in the field of CAR T cell biology over the coming years in the areas of safety, reliability and efficacy against non-hematopoietic cancers will ultimately determine how transformative adoptive T cell therapy will be in the broader battle against cancer.
Collapse
Affiliation(s)
- Kristen B Long
- Department of Biology, Mansfield University, Mansfield, PA, United States
| | - Regina M Young
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA, United States
| | - Alina C Boesteanu
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Megan M Davis
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - J Joseph Melenhorst
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Simon F Lacey
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David A DeGaramo
- Department of Biology, Mansfield University, Mansfield, PA, United States
| | - Bruce L Levine
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph A Fraietta
- Center for Cellular Immunotherapies, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
3502
|
Beck J, Birtel M, Reidenbach D, Salomon N, Diken M. CIMT 2018: Pushing frontiers in cancer immunotherapy — Report on the 16 th Annual Meeting of the Association for Cancer Immunotherapy. Hum Vaccin Immunother 2018; 14:2864-2873. [PMID: 30111232 PMCID: PMC6343606 DOI: 10.1080/21645515.2018.1504526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The 16th Annual Meeting of the Association for Cancer Immunotherapy (CIMT), Europe’s largest meeting series of its kind, took place in Mainz, Germany from 15–17 May, 2018. Cutting-edge advancements in cancer immunotherapy were discussed among more than 700 scientists under the motto “Pushing Frontiers in Cancer Immunotherapy”. This meeting report is a summary of some of the CIMT 2018 highlights.
Collapse
Affiliation(s)
- Jan Beck
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - Matthias Birtel
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - Daniel Reidenbach
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - Nadja Salomon
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - Mustafa Diken
- TRON-Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| |
Collapse
|
3503
|
Locke FL, Ghobadi A, Jacobson CA, Miklos DB, Lekakis LJ, Oluwole OO, Lin Y, Braunschweig I, Hill BT, Timmerman JM, Deol A, Reagan PM, Stiff P, Flinn IW, Farooq U, Goy A, McSweeney PA, Munoz J, Siddiqi T, Chavez JC, Herrera AF, Bartlett NL, Wiezorek JS, Navale L, Xue A, Jiang Y, Bot A, Rossi JM, Kim JJ, Go WY, Neelapu SS. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1-2 trial. Lancet Oncol 2018; 20:31-42. [PMID: 30518502 DOI: 10.1016/s1470-2045(18)30864-7] [Citation(s) in RCA: 1423] [Impact Index Per Article: 237.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Axicabtagene ciloleucel is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy. In the previous analysis of the ZUMA-1 registrational study, with a median follow-up of 15·4 months (IQR 13·7-17·3), 89 (82%) of 108 assessable patients with refractory large B-cell lymphoma treated with axicabtagene ciloleucel achieved an objective response, and complete responses were noted in 63 (58%) patients. Here we report long-term activity and safety outcomes of the ZUMA-1 study. METHODS ZUMA-1 is a single-arm, multicentre, registrational trial at 22 sites in the USA and Israel. Eligible patients were aged 18 years or older, and had histologically confirmed large B-cell lymphoma-including diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, and transformed follicular lymphoma-according to the 2008 WHO Classification of Tumors of Hematopoietic and Lymphoid Tissue; refractory disease or relapsed after autologous stem-cell transplantation; an Eastern Cooperative Oncology Group performance status of 0 or 1; and had previously received an anti-CD20 monoclonal antibody containing-regimen and an anthracycline-containing chemotherapy. Participants received one dose of axicabtagene ciloleucel on day 0 at a target dose of 2 × 106 CAR T cells per kg of bodyweight after conditioning chemotherapy with intravenous fludarabine (30 mg/m2 body-surface area) and cyclophosphamide (500 mg/m2 body-surface area) on days -5, -4, and -3. The primary endpoints were safety for phase 1 and the proportion of patients achieving an objective response for phase 2, and key secondary endpoints were overall survival, progression-free survival, and duration of response. Pre-planned activity and safety analyses were done per protocol. ZUMA-1 is registered with ClinicalTrials.gov, number NCT02348216. Although the registrational cohorts are closed, the trial remains open, and recruitment to extension cohorts with alternative endpoints is underway. FINDINGS Between May 19, 2015, and Sept 15, 2016, 119 patients were enrolled and 108 received axicabtagene ciloleucel across phases 1 and 2. As of the cutoff date of Aug 11, 2018, 101 patients assessable for activity in phase 2 were followed up for a median of 27·1 months (IQR 25·7-28·8), 84 (83%) had an objective response, and 59 (58%) had a complete response. The median duration of response was 11·1 months (4·2-not estimable). The median overall survival was not reached (12·8-not estimable), and the median progression-free survival was 5·9 months (95% CI 3·3-15·0). 52 (48%) of 108 patients assessable for safety in phases 1 and 2 had grade 3 or worse serious adverse events. Grade 3 or worse cytokine release syndrome occurred in 12 (11%) patients, and grade 3 or worse neurological events in 35 (32%). Since the previous analysis at 1 year, additional serious adverse events were reported in four patients (grade 3 mental status changes, grade 4 myelodysplastic syndrome, grade 3 lung infection, and two episodes of grade 3 bacteraemia), none of which were judged to be treatment related. Two treatment-related deaths (due to haemophagocytic lymphohistiocytosis and cardiac arrest) were previously reported, but no new treatment-related deaths occurred during the additional follow-up. INTERPRETATION These 2-year follow-up data from ZUMA-1 suggest that axicabtagene ciloleucel can induce durable responses and a median overall survival of greater than 2 years, and has a manageable long-term safety profile in patients with relapsed or refractory large B-cell lymphoma. FUNDING Kite and the Leukemia & Lymphoma Society Therapy Acceleration Program.
Collapse
Affiliation(s)
| | - Armin Ghobadi
- Washington University School of Medicine, St Louis, MO, USA
| | | | - David B Miklos
- Stanford University School of Medicine, Stanford, CA, USA
| | - Lazaros J Lekakis
- University of Miami Health System, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
| | - Ira Braunschweig
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Abhinav Deol
- Karmanos Cancer Center, Wayne State University, Detroit, MI, USA
| | | | - Patrick Stiff
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack, NJ, USA
| | | | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Tanya Siddiqi
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3504
|
|
3505
|
Roth JA, Sullivan SD, Lin VW, Bansal A, Purdum AG, Navale L, Cheng P, Ramsey SD. Cost-effectiveness of axicabtagene ciloleucel for adult patients with relapsed or refractory large B-cell lymphoma in the United States. J Med Econ 2018; 21:1238-1245. [PMID: 30260711 DOI: 10.1080/13696998.2018.1529674] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Axicabtagene ciloleucel (axi-cel) was recently approved for treatment of relapsed or refractory (R/R) large B-cell lymphoma (LBCL) following two or more prior therapies. As the first CAR T-cell therapy available for adults in the US, there are important questions about clinical and economic value. The objective of this study was to assess the cost-effectiveness of axi-cel compared to salvage chemotherapy using a decision model and a US payer perspective. MATERIALS AND METHODS A decision model was developed to estimate life years (LYs), quality-adjusted life years (QALYs), and lifetime cost for adult patients with R/R LBCL treated with axi-cel vs salvage chemotherapy (R-DHAP). Patient-level analyses of the ZUMA-1 and SCHOLAR-1 studies were used to inform the model and to estimate the proportion achieving long-term survival. Drug and procedure costs were derived from US average sales prices and Medicare reimbursement schedules. Future healthcare costs in long-term remission was derived from per capita Medicare spending. Utility values were derived from patient-level data from ZUMA-1 and external literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. Outcomes were calculated over a lifetime horizon and were discounted at 3% per year. RESULTS In the base case, LYs, QALYs, and lifetime costs were 9.5, 7.7, and $552,921 for axi-cel vs 2.6, 1.1, and $172,737 for salvage chemotherapy, respectively. The axi-cel cost per QALY gained was $58,146. Cost-effectiveness was most sensitive to the fraction achieving long-term remission, discount rate, and axi-cel price. The likelihood that axi-cel is cost-effective was 95% at a willingness to pay of $100,000 per QALY. CONCLUSION Axi-cel is a potentially cost-effective alternative to salvage chemotherapy for adults with R/R LBCL. Long-term follow-up is necessary to reduce uncertainties about health outcomes.
Collapse
MESH Headings
- Antigens, CD19/adverse effects
- Antigens, CD19/economics
- Antigens, CD19/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biological Products
- Cost-Benefit Analysis
- Decision Support Techniques
- Fees, Pharmaceutical/statistics & numerical data
- Health Expenditures/statistics & numerical data
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/economics
- Immunotherapy, Adoptive/methods
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/mortality
- Models, Econometric
- Quality-Adjusted Life Years
- Recurrence
- Salvage Therapy/economics
- Survival Analysis
- United States
Collapse
Affiliation(s)
- Joshua A Roth
- a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute , Seattle , WA , USA
- b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy , University of Washington , Seattle , WA , USA
| | - Sean D Sullivan
- a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute , Seattle , WA , USA
- b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy , University of Washington , Seattle , WA , USA
| | | | - Aasthaa Bansal
- a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute , Seattle , WA , USA
- b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy , University of Washington , Seattle , WA , USA
| | | | - Lynn Navale
- c Kite, a Gilead Company , Santa Monica , CA , USA
| | - Paul Cheng
- c Kite, a Gilead Company , Santa Monica , CA , USA
| | - Scott D Ramsey
- a Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute , Seattle , WA , USA
- b Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy , University of Washington , Seattle , WA , USA
| |
Collapse
|
3506
|
Abstract
Neurotoxicity is an important and common complication of chimeric antigen receptor-T cell therapies. Acute neurologic signs and/or symptoms occur in a significant proportion of patients treated with CD19-directed chimeric antigen receptor-T cells for B-cell malignancies. Clinical manifestations include headache, confusion, delirium, language disturbance, seizures and rarely, acute cerebral edema. Neurotoxicity is associated with cytokine release syndrome, which occurs in the setting of in-vivo chimeric antigen receptor-T cell activation and proliferation. The mechanisms that lead to neurotoxicity remain unknown, but data from patients and animal models suggest there is compromise of the blood-brain barrier, associated with high levels of cytokines in the blood and cerebrospinal fluid, as well as endothelial activation. Corticosteroids, interleukin-6-targeted therapies, and supportive care are frequently used to manage patients with neurotoxicity, but high-quality evidence of their efficacy is lacking.
Collapse
Affiliation(s)
- Juliane Gust
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA,Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA, USA
| | - Agne Taraseviciute
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Cameron J. Turtle
- Clinical Research Division and Integrated Immunotherapy Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
3507
|
Jacoby E, Bielorai B, Avigdor A, Itzhaki O, Hutt D, Nussboim V, Meir A, Kubi A, Levy M, Zikich D, Zeltzer LA, Brezinger K, Schachter J, Nagler A, Besser MJ, Toren A. Locally produced CD19 CAR T cells leading to clinical remissions in medullary and extramedullary relapsed acute lymphoblastic leukemia. Am J Hematol 2018; 93:1485-1492. [PMID: 30187944 DOI: 10.1002/ajh.25274] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 01/02/2023]
Abstract
Autologous CD19 chimeric-antigen receptor (CAR) T cells demonstrated remarkable remission rates in relapsed and refractory acute lymphoblastic leukemia (R/R ALL). Here, we report results from a phase 1b/2 study of in-house produced CD19 CAR with a CD28 costimulatory domain. Twenty-one patients with R/R ALL were enrolled, and 20 infused. The median age was 11 years (range, 5-48). Patients had a median of 4 prior regimens, including blinatumomab in 6 and prior stem-cell transplantation in 10. In total 8 patients had extramedullary (EM) leukemic involvement, and prior to lymphodepletion and CAR 7 had active lesions, a group underrepresented in previous trials. In vivo expansion of CAR T cells was observed in 18 patients. In total 16 patients developed cytokine release syndrome, and 11 patients developed neurotoxicity, with no toxic deaths. All responding patients were referred to an allogeneic hematopoietic stem-cell transplantation. The remission rate was 90%, including resolution of all refractory EM sites. Four responding patients relapsed, 3 who had a PCR-MRD positive remission at 28 days following CAR-T cells and 1 patient 21 months after an MRD-negative response. The estimated 1-year event-free survival and overall survival are 73% and 90%, respectively. Patients with R/R EM ALL may also benefit from CAR-T cell therapy.
Collapse
Affiliation(s)
- Elad Jacoby
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Bella Bielorai
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Division of Hematology and Bone Marrow Transplantation; Sheba Medical Center; Tel Hashomer Israel
| | - Orit Itzhaki
- Division of Hematology and Bone Marrow Transplantation; Sheba Medical Center; Tel Hashomer Israel
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Daphna Hutt
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
| | - Vered Nussboim
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
| | - Amilia Meir
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
| | - Adva Kubi
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Michal Levy
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Dragoslav Zikich
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Li-at Zeltzer
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Karin Brezinger
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Jacob Schachter
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - Arnon Nagler
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Division of Hematology and Bone Marrow Transplantation; Sheba Medical Center; Tel Hashomer Israel
| | - Michal J. Besser
- Ella Lemelbaum Institute of Immuno-Oncology; Sheba Medical Center; Tel Hashomer Israel
- Department of Clinical Microbiology and Immunology; Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Amos Toren
- Division of Pediatric Hematology and Oncology; The Edmond and Lily Safra Children's Hospital, Sheba Medical Center; Tel Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
3508
|
LaRiviere MJ, Pinnix CC, Plastaras JP. Immune Therapies for Lymphomas: A Disruptive Technology With Opportunities for Radiation. Int J Radiat Oncol Biol Phys 2018; 102:1396-1399. [DOI: 10.1016/j.ijrobp.2018.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022]
|
3509
|
Appelbaum JS, Milano F. Hematopoietic Stem Cell Transplantation in the Era of Engineered Cell Therapy. Curr Hematol Malig Rep 2018; 13:484-493. [PMID: 30280289 PMCID: PMC6333424 DOI: 10.1007/s11899-018-0476-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Cellular therapy using T cells modified to express chimeric antigen receptors (CAR-T cells) has had striking success in patients that have failed previous treatment for CD19+ B cell non-Hodgkin lymphoma (NHL), chronic lymphocytic leukemia (CLL), or acute lymphoblastic leukemia (ALL). Curative therapy for this group of diseases has previously been limited to allogeneic hematopoietic cell transplantation HCT (alloHCT). The recent results of CAR-T cell therapy raise the question of how best to integrate CAR-T cell therapy and alloHCT in the care of these patients. RECENT FINDINGS Within the past 2 years, results from larger trials and increased follow-up of patients treated with CD19 CAR-T cell therapy suggest that some may achieve durable remission without transplant. The balance of efficacy and toxicity for CAR-T cell therapy and alloHCT vary by disease type, disease status at the time of treatment, patient characteristics, and the specific therapy employed. There are early signals that subsequent transplantation of patients who have achieved remission with CAR-T may be a potentially viable (though expensive) strategy.
Collapse
Affiliation(s)
- Jacob S Appelbaum
- Department of Medicine, University of Washington, 1100 Fairview AVE N, Mailstop # D5-100, Seattle, WA, 98109, USA.
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Filippo Milano
- Department of Medicine, University of Washington, 1100 Fairview AVE N, Mailstop # D5-100, Seattle, WA, 98109, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
3510
|
Dourthe MÉ, Yakouben K, Chaillou D, Lesprit E, Dalle JH, Baruchel A. CAR-T cells : indications actuelles en pédiatrie et perspectives de développement. Bull Cancer 2018; 105 Suppl 2:S147-S157. [DOI: 10.1016/s0007-4551(19)30045-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
3511
|
Cohen JB. Novel therapies for relapsed/refractory aggressive lymphomas. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:75-82. [PMID: 30504294 PMCID: PMC6245978 DOI: 10.1182/asheducation-2018.1.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most patients with aggressive non-Hodgkin lymphoma will be cured with initial chemoimmunotherapy; however, most patients with relapsed disease will not be cured and will die as a result of their disease. In these cases, continued treatment with conventional chemotherapy is typically not of benefit and can contribute to significant toxicities and decreased quality of life for patients. Fortunately, a number of therapies are currently available or under investigation for this group of patients, ranging from oral tyrosine kinase inhibitors targeting multiple pathways within the malignant cells to adoptive cellular therapies that harness the patient's immune system to fight disease. Additionally, many agents that are modestly effective as monotherapies can be safely combined with additional novel and conventional therapies to improve response rates and duration. Chimeric antigen receptor T cells are among the most promising group of therapies and provide the potential for cure for patients with relapsed/refractory lymphoma. In this chapter, we will review the currently available novel treatments as well as those still under investigation and discuss the most appropriate approach to patients with relapsed/refractory aggressive lymphoma. We will highlight the challenges associated with these therapies, as well as potential toxicities, and the need for additional clinical trials evaluating combinations and newer treatments.
Collapse
Affiliation(s)
- Jonathon B Cohen
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| |
Collapse
|
3512
|
Flowers CR, Leonard JP, Nastoupil LJ. Novel immunotherapy approaches to follicular lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:194-199. [PMID: 30504310 PMCID: PMC6245999 DOI: 10.1182/asheducation-2018.1.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Follicular lymphoma (FL) remains a lymphoma subtype that is remarkably sensitive to immunotherapy-based treatment strategies. Anti-CD20 antibody therapy administered as a single agent and in combination as a first-line treatment and at relapse continues to be the most broadly used therapy for this disease. Autologous and allogeneic stem cell transplantation provide meaningful durable remissions for patients with FL. However, identifying the most suitable patients and the optimal timing for these approaches has become increasingly challenging with the advent of novel therapies. Lenalidomide and phosphatidylinositol 3-kinase inhibitors are emerging as agents that can be applied in the relapsed setting. Other immunotherapy approaches, including checkpoint inhibitors and chimeric antigen receptor T cells, appear promising but remain experimental. Utilization of all forms of immunotherapy requires careful consideration of the unique toxicities associated with these agents and the means to mitigate them by selection of appropriate patients, optimal timing, and the use of supportive care.
Collapse
Affiliation(s)
- Christopher R. Flowers
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - John P. Leonard
- Weill Cornell Medicine and Division of Hematology and Medical Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY; and
| | - Loretta J. Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
3513
|
Chakraborty R, Sidana S, Shah GL, Scordo M, Hamilton BK, Majhail NS. Patient-Reported Outcomes with Chimeric Antigen Receptor T Cell Therapy: Challenges and Opportunities. Biol Blood Marrow Transplant 2018; 25:e155-e162. [PMID: 30500439 DOI: 10.1016/j.bbmt.2018.11.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
Abstract
Patient-reported outcomes (PROs) are an important tool to assess the impact of a new therapy on symptom burden and health-related quality of life (HRQoL). Chimeric antigen receptor T (CAR-T) cell therapies have been approved for use in relapsed or refractory leukemia and lymphoma based on promising efficacy in clinical trials. However, data are lacking on patient-reported toxicity and impact on HRQoL. This review provides an overview of the incorporation of PROs in CAR-T cell therapy and the specific challenges in this context. The first step is to demonstrate feasibility of PRO monitoring in the acute phase after CAR-T cell infusion. Apart from core PRO domains like physical functioning, disease-related symptoms, and symptomatic adverse effects, important measures to consider are cognitive functioning and financial toxicity. Because there are no validated PRO instruments in the setting of CAR-T cell therapy, universally validated measures like Patient-Reported Outcomes Measurement Information System (PROMIS) could be considered, which is also recommended in the setting of hematopoietic stem cell transplantation. Given the timeline of toxicities with CAR-T cell therapy, PRO instruments should be administered at baseline and at least weekly in the first 30 days. Subsequently, frequent monitoring of PROs in the first year might be helpful in identifying short- and intermediate-term toxicities, functional limitations, and neuropsychiatric effects. The major potential challenge in acute phase would be missing data when patients develop severe cytokine release syndrome or neurotoxicity. Designing a strategy for handling missing data is crucial. The long-term safety of CAR-T cell therapy is not well characterized because of short follow-up in most studies reported thus far. PROs should be measured at least yearly after the first year to identify potential late effects like cognitive deficit or autoimmune manifestations. Collaboration between institutions performing cellular therapy and engagement with patients, clinicians, and statisticians with expertise in PROs are crucial for setting a comprehensive agenda on integration of PROs with CAR-T cell therapy.
Collapse
Affiliation(s)
| | - Surbhi Sidana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | |
Collapse
|
3514
|
Abstract
Lymphomas in adolescents and young adults represent approximately one quarter of all cancers in this age group. Historically, adolescent and young adult cancer patients represent a unique population with diverging issues surrounding psychosocial hardships/barriers, economics, and lack of standardization of therapeutic approaches.Furthermore, the biologic differences within the adolescent and young adult population seen in various lymphoma subtypes likely play a role in overall outcomes for this group. Without an organized approach to clinical and translational research for adolescent and young adult patients within specialized treatment centers, this population may continue to experience inferior results. Here we look at the current perspectives of adolescent and young adult lymphomas with respect to disease biology, clinical characteristics, treatment, and prognosis of this unique lymphoma population.
Collapse
|
3515
|
Heudobler D, Rechenmacher M, Lüke F, Vogelhuber M, Klobuch S, Thomas S, Pukrop T, Hackl C, Herr W, Ghibelli L, Gerner C, Reichle A. Clinical Efficacy of a Novel Therapeutic Principle, Anakoinosis. Front Pharmacol 2018; 9:1357. [PMID: 30546308 PMCID: PMC6279883 DOI: 10.3389/fphar.2018.01357] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
Classic tumor therapy, consisting of cytotoxic agents and/or targeted therapy, has not overcome therapeutic limitations like poor risk genetic parameters, genetic heterogeneity at different metastatic sites or the problem of undruggable targets. Here we summarize data and trials principally following a completely different treatment concept tackling systems biologic processes: the principle of communicative reprogramming of tumor tissues, i.e., anakoinosis (ancient greek for communication), aims at establishing novel communicative behavior of tumor tissue, the hosting organ and organism via re-modeling gene expression, thus recovering differentiation, and apoptosis competence leading to cancer control - in contrast to an immediate, "poisoning" with maximal tolerable doses of targeted or cytotoxic therapies. Therefore, we introduce the term "Master modulators" for drugs or drug combinations promoting evolutionary processes or regulating homeostatic pathways. These "master modulators" comprise a broad diversity of drugs, characterized by the capacity for reprogramming tumor tissues, i.e., transcriptional modulators, metronomic low-dose chemotherapy, epigenetically modifying agents, protein binding pro-anakoinotic drugs, such as COX-2 inhibitors, IMiDs etc., or for example differentiation inducing therapies. Data on 97 anakoinosis inducing schedules indicate a favorable toxicity profile: The combined administration of master modulators, frequently (with poor or no monoactivity) may even induce continuous complete remission in refractory metastatic neoplasia, irrespectively of the tumor type. That means recessive components of the tumor, successively developing during tumor ontogenesis, are accessible by regulatory active drug combinations in a therapeutically meaningful way. Drug selection is now dependent on situative systems characteristics, to less extent histology dependent. To sum up, anakoinosis represents a new substantive therapy principle besides novel targeted therapies.
Collapse
Affiliation(s)
- Daniel Heudobler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Rechenmacher
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Lüke
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Klobuch
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Simone Thomas
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Lina Ghibelli
- Department Biology, Universita' di Roma Tor Vergata, Rome, Italy
| | - Christopher Gerner
- Faculty Chemistry, Institut for Analytical Chemistry, University Vienna, Vienna, Austria
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
3516
|
Lee YG, Marks I, Srinivasarao M, Kanduluru AK, Mahalingam SM, Liu X, Chu H, Low PS. Use of a Single CAR T Cell and Several Bispecific Adapters Facilitates Eradication of Multiple Antigenically Different Solid Tumors. Cancer Res 2018; 79:387-396. [PMID: 30482775 DOI: 10.1158/0008-5472.can-18-1834] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Most solid tumors are comprised of multiple clones that express orthogonal antigens, suggesting that novel strategies must be developed in order to adapt chimeric antigen receptor (CAR) T-cell therapies to treat heterogeneous solid tumors. Here, we utilized a cocktail of low-molecular-weight bispecific adapters, each comprised of fluorescein linked to a different tumor-specific ligand, to bridge between an antifluorescein CAR on the engineered T cell and a unique antigen on the cancer cell. This formation of an immunologic synapse between the CAR T cell and cancer cell enabled use of a single antifluorescein CAR T cell to eradicate a diversity of antigenically different solid tumors implanted concurrently in NSG mice. Based on these data, we suggest that a carefully designed cocktail of bispecific adapters in combination with antifluorescein CAR T cells can overcome tumor antigen escape mechanisms that lead to disease recurrence following many CAR T-cell therapies. SIGNIFICANCE: A cocktail of tumor-targeted bispecific adapters greatly augments CAR T-cell therapies against heterogeneous tumors, highlighting its potential for broader applicability against cancers where standard CAR T-cell therapy has failed.
Collapse
Affiliation(s)
- Yong Gu Lee
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Isaac Marks
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Madduri Srinivasarao
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Ananda Kumar Kanduluru
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Sakkarapalayam M Mahalingam
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Xin Liu
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | | | - Philip S Low
- Department of Chemistry, Purdue Institute for Drug Discovery, and Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana.
| |
Collapse
|
3517
|
Yu J, Wang W, Huang H. Efficacy and safety of bispecific T-cell engager (BiTE) antibody blinatumomab for the treatment of relapsed/refractory acute lymphoblastic leukemia and non-Hodgkin’s lymphoma: a systemic review and meta-analysis. Hematology 2018; 24:199-207. [PMID: 30479190 DOI: 10.1080/16078454.2018.1549802] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jian Yu
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, People’s Republic of China
| | - Wen Wang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, People’s Republic of China
| | - He Huang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, People’s Republic of China
| |
Collapse
|
3518
|
Kanesvaran R, Cordoba R, Maggiore R. Immunotherapy in Older Adults With Advanced Cancers: Implications for Clinical Decision-Making and Future Research. Am Soc Clin Oncol Educ Book 2018; 38:400-414. [PMID: 30231397 DOI: 10.1200/edbk_201435] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunotherapy has expanded the therapeutic landscape for advanced cancers, including solid tumors and lymphomas. For many patients with cancer, these agents have been shown to have substantial efficacy and favorable toxicity compared with cytotoxic agents, particularly in the second-line setting. With the advent of anti-PD-1 and anti-PD-L1 checkpoint inhibitors, combination immunotherapy- and chemoimmunotherapy-based strategies have emerged as promising novel regimens to improve cancer-related outcomes. Older adults age 65 or older represent the growing majority of patients diagnosed with cancer. However, older adults are under-represented in clinical trials in general, as well as in the landmark studies that led to approval of these immunotherapy agents. Because of increasing age and attendant multimorbidity and impaired functional status, many of these patients seen in the community-based oncology practices would not have been considered eligible for such studies. Thus, the results of these studies are difficult to generalize to a broader patient population with these competing risks. Furthermore, robust evaluation of toxicities, effect on quality of life and functional status, and aging-related (i.e., immunosenescence) and immunotherapy-related changes affecting the immune system remain underexplored research areas for older adults. This review examines the role of immunotherapy and its unique issues, specifically in older adults with lung cancer, bladder cancer, and lymphomas.
Collapse
Affiliation(s)
- Ravindran Kanesvaran
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
| | - Raul Cordoba
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
| | - Ronald Maggiore
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
| |
Collapse
|
3519
|
Munshi PN, Ujjani C. The acceleration of CAR‐T therapy in non‐Hodgkin lymphoma. Hematol Oncol 2018; 37:233-239. [DOI: 10.1002/hon.2568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Pashna N. Munshi
- Lombardi Comprehensive Cancer CenterMedStar Georgetown University Hospital Washington DC USA
| | - Chaitra Ujjani
- Seattle Cancer Care AllianceUniversity of Washington/Fred Hutchinson Cancer Research Center Seattle Seattle Washington USA
| |
Collapse
|
3520
|
Abstract
Gene therapies are gaining momentum as promising early successes in clinical studies accumulate and examples of regulatory approval for licensing increase. Investigators are advancing with cautious optimism that effective, durable, and safe therapies will provide benefit to patients-not only those with single-gene disorders but those with complex acquired diseases as well. While the strategies being translated from the lab to the clinic are numerous, this review focuses on the clinical research that has forged the gene therapy field as it currently stands.
Collapse
Affiliation(s)
- Xavier M Anguela
- Spark Therapeutics, Inc., Philadelphia, Pennsylvania 19104, USA; ,
| | - Katherine A High
- Spark Therapeutics, Inc., Philadelphia, Pennsylvania 19104, USA; ,
| |
Collapse
|
3521
|
Adoptive cellular therapies: the current landscape. Virchows Arch 2018; 474:449-461. [PMID: 30470934 PMCID: PMC6447513 DOI: 10.1007/s00428-018-2484-0] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/11/2022]
Abstract
For many cancer types, the immune system plays an essential role in their development and growth. Based on these rather novel insights, immunotherapeutic strategies have been developed. In the past decade, immune checkpoint blockade has demonstrated a major breakthrough in cancer treatment and has currently been approved for the treatment of multiple tumor types. Adoptive cell therapy (ACT) with tumor-infiltrating lymphocytes (TIL) or gene-modified T cells expressing novel T cell receptors (TCR) or chimeric antigen receptors (CAR) is another strategy to modify the immune system to recognize tumor cells and thus carry out an anti-tumor effector function. These treatments have shown promising results in various tumor types, and multiple clinical trials are being conducted worldwide to further optimize this treatment modality. Most successful results were obtained in hematological malignancies with the use of CD19-directed CAR T cell therapy and already led to the commercial approval by the FDA. This review provides an overview of the developments in ACT, the associated toxicity, and the future potential of ACT in cancer treatment.
Collapse
|
3522
|
GM-CSF inhibition reduces cytokine release syndrome and neuroinflammation but enhances CAR-T cell function in xenografts. Blood 2018; 133:697-709. [PMID: 30463995 DOI: 10.1182/blood-2018-10-881722] [Citation(s) in RCA: 436] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/14/2018] [Indexed: 01/18/2023] Open
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy is a new pillar in cancer therapeutics; however, its application is limited by the associated toxicities. These include cytokine release syndrome (CRS) and neurotoxicity. Although the IL-6R antagonist tocilizumab is approved for treatment of CRS, there is no approved treatment of neurotoxicity associated with CD19-targeted CAR-T (CART19) cell therapy. Recent data suggest that monocytes and macrophages contribute to the development of CRS and neurotoxicity after CAR-T cell therapy. Therefore, we investigated neutralizing granulocyte-macrophage colony-stimulating factor (GM-CSF) as a potential strategy to manage CART19 cell-associated toxicities. In this study, we show that GM-CSF neutralization with lenzilumab does not inhibit CART19 cell function in vitro or in vivo. Moreover, CART19 cell proliferation was enhanced and durable control of leukemic disease was maintained better in patient-derived xenografts after GM-CSF neutralization with lenzilumab. In a patient acute lymphoblastic leukemia xenograft model of CRS and neuroinflammation (NI), GM-CSF neutralization resulted in a reduction of myeloid and T cell infiltration in the central nervous system and a significant reduction in NI and prevention of CRS. Finally, we generated GM-CSF-deficient CART19 cells through CRISPR/Cas9 disruption of GM-CSF during CAR-T cell manufacturing. These GM-CSFk/o CAR-T cells maintained normal functions and had enhanced antitumor activity in vivo, as well as improved overall survival, compared with CART19 cells. Together, these studies illuminate a novel approach to abrogate NI and CRS through GM-CSF neutralization, which may potentially enhance CAR-T cell function. Phase 2 studies with lenzilumab in combination with CART19 cell therapy are planned.
Collapse
|
3523
|
Cornell RF, Costa LJ. The Future of Chimeric Antigen Receptor T Cell Therapy for the Treatment of Multiple Myeloma. Biol Blood Marrow Transplant 2018; 25:e73-e75. [PMID: 30448457 DOI: 10.1016/j.bbmt.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- R Frank Cornell
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
| |
Collapse
|
3524
|
Rataj F, Jacobi SJ, Stoiber S, Asang F, Ogonek J, Tokarew N, Cadilha BL, van Puijenbroek E, Heise C, Duewell P, Endres S, Klein C, Kobold S. High-affinity CD16-polymorphism and Fc-engineered antibodies enable activity of CD16-chimeric antigen receptor-modified T cells for cancer therapy. Br J Cancer 2018; 120:79-87. [PMID: 30429531 PMCID: PMC6325122 DOI: 10.1038/s41416-018-0341-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND CD16-chimeric antigen receptors (CAR) T cells recognise the Fc-portion of therapeutic antibodies, which can enable the selective targeting of different antigens. Limited evidence exists as to which CD16-CAR design and antibody partner might be most effective. We have hypothesised that the use of high-affinity CD16 variants, with increased Fc-terminus antibody affinity, combined with Fc-engineered antibodies, would provide superior CD16-CAR T cell efficacy. METHODS CD16-CAR T (wild-type or variants) cells were co-cultured with Panc-1 pancreatic cancer, Raji lymphoma or A375 melanoma cells in the presence or absence of anti-CD20, anti-MCSP, wild-type or the glycoengineered antibody variants. The endpoints were proliferation, activation, and cytotoxicity in vitro. RESULTS The CD16 158 V variant of CD16-CAR T cells showed increased cytotoxic activity against all the tested cancer cells in the presence of the wild-type antibody directed against MCSP or CD20. Glycoengineered antibodies enhanced CD16-CAR T cell activity irrespective of CD16 polymorphisms as compared with the wild-type antibody. The combination of the glycoengineered antibodies with the CD16-CAR 158 V variant synergised as seen by the increase in all endpoints. CONCLUSION These results indicate that CD16-CAR with the high-affinity CD16 variant 158 V, combined with Fc-engineered antibodies, have high anti-tumour efficacy.
Collapse
Affiliation(s)
- Felicitas Rataj
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Severin J Jacobi
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Stefan Stoiber
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Florian Asang
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Justyna Ogonek
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Nicholas Tokarew
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Bruno L Cadilha
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | | | - Constanze Heise
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Peter Duewell
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | - Stefan Endres
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany
| | | | - Sebastian Kobold
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, Klinikum der Universität München, LMU Munich (Member of the German Center for Lung Research (DZL), LMU Munich, Germany.
| |
Collapse
|
3525
|
Larimer BM. Reporter Genes for PET Imaging of CAR T Cells Offers Insight into Adoptive Cell Transfer. J Nucl Med 2018; 59:1892-1893. [PMID: 30442751 DOI: 10.2967/jnumed.118.220897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Benjamin M Larimer
- Center for Precision Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
3526
|
Immunotherapy: A Novel Era of Promising Treatments for Multiple Myeloma. Int J Mol Sci 2018; 19:ijms19113613. [PMID: 30445802 PMCID: PMC6274949 DOI: 10.3390/ijms19113613] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 01/24/2023] Open
Abstract
Multiple myeloma (MM) remains an incurable hematological malignancy characterized by clonal proliferation of malignant plasma cells in bone marrow. In the last 20 years, the introduction of autologous stem cell transplantation, followed by proteasome inhibitors and immunomodulatory agents, increased the survival of MM patients by 50%. However, still a high proportion of patients relapse and become refractory, especially, high-risk patients with adverse cytogenetics where these treatment combinations have shown limited benefit. Therefore, novel strategies, such as immunotherapy, have been developed in the last few years to help improve the survival of these patients. Immunotherapy treatments include a high number of different strategies used to attack the tumor cells by using the immune system. Here, we will review the most successful immunotherapy strategies published up to date in patients with relapsed or refractory (R/R) MM, including monoclonal antibodies targeting specific antigens on the tumor cells, antibodies combined with cytotoxic drugs or Antibodies Drug Conjugates, immune checkpoint inhibitors which eliminate the barriers that damper immune cells and prevent them from attacking tumor cells, bi-specific T-cell engagers antibodies (BiTEs), bi-specific antibodies and the infusion of chimeric antigen receptor-modified T cells. We overview the results of clinical studies that have been presented up to date and also review pre-clinical studies describing potential novel treatments for MM.
Collapse
|
3527
|
Brudno JN, Kochenderfer JN. Recent advances in CAR T-cell toxicity: Mechanisms, manifestations and management. Blood Rev 2018; 34:45-55. [PMID: 30528964 DOI: 10.1016/j.blre.2018.11.002] [Citation(s) in RCA: 521] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/12/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is an effective new treatment for hematologic malignancies. Two CAR T-cell products are now approved for clinical use by the U.S. FDA: tisagenlecleucel for pediatric acute lymphoblastic leukemia (ALL) and adult diffuse large B-cell lymphoma subtypes (DLBCL), and axicabtagene ciloleucel for DLBCL. CAR T-cell therapies are being developed for multiple myeloma, and clear evidence of clinical activity has been generated. A barrier to widespread use of CAR T-cell therapy is toxicity, primarily cytokine release syndrome (CRS) and neurologic toxicity. Manifestations of CRS include fevers, hypotension, hypoxia, end organ dysfunction, cytopenias, coagulopathy, and hemophagocytic lymphohistiocytosis. Neurologic toxicities are diverse and include encephalopathy, cognitive defects, dysphasias, seizures, and cerebral edema. Our understanding of the pathophysiology of CRS and neurotoxicity is continually improving. Early and peak levels of certain cytokines, peak blood CAR T-cell levels, patient disease burden, conditioning chemotherapy, CAR T-cell dose, endothelial activation, and CAR design are all factors that may influence toxicity. Multiple grading systems for CAR T-cell toxicity are in use; a universal grading system is needed so that CAR T-cell products can be compared across studies. Guidelines for toxicity management vary among centers, but typically include supportive care, plus immunosuppression with tocilizumab or corticosteroids administered for severe toxicity. Gaining a better understanding of CAR T-cell toxicities and developing new therapies for these toxicities are active areas of laboratory research. Further clinical investigation of CAR T-cell toxicity is also needed. In this review, we present guidelines for management of CRS and CAR neurotoxicity.
Collapse
Affiliation(s)
- Jennifer N Brudno
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Building 10, Suite 3-3330, Bethesda, MD 20892, United States.
| | - James N Kochenderfer
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Building 10, Suite 3-3330, Bethesda, MD 20892, United States.
| |
Collapse
|
3528
|
Falzone L, Salomone S, Libra M. Evolution of Cancer Pharmacological Treatments at the Turn of the Third Millennium. Front Pharmacol 2018; 9:1300. [PMID: 30483135 PMCID: PMC6243123 DOI: 10.3389/fphar.2018.01300] [Citation(s) in RCA: 495] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
The medical history of cancer began millennia ago. Historical findings of patients with cancer date back to ancient Egyptian and Greek civilizations, where this disease was predominantly treated with radical surgery and cautery that were often ineffective, leading to the death of patients. Over the centuries, important discoveries allowed to identify the biological and pathological features of tumors, without however contributing to the development of effective therapeutic approaches until the end of the 1800s, when the discovery of X-rays and their use for the treatment of tumors provided the first modern therapeutic approach in medical oncology. However, a real breakthrough took place after the Second World War, with the discovery of cytotoxic antitumor drugs and the birth of chemotherapy for the treatment of various hematological and solid tumors. Starting from this epochal turning point, there has been an exponential growth of studies concerning the use of new drugs for cancer treatment. The second fundamental breakthrough in the field of oncology and pharmacology took place at the beginning of the '80s, thanks to molecular and cellular biology studies that allowed the development of specific drugs for some molecular targets involved in neoplastic processes, giving rise to targeted therapy. Both chemotherapy and target therapy have significantly improved the survival and quality of life of cancer patients inducing sometimes complete tumor remission. Subsequently, at the turn of the third millennium, thanks to genetic engineering studies, there was a further advancement of clinical oncology and pharmacology with the introduction of monoclonal antibodies and immune checkpoint inhibitors for the treatment of advanced or metastatic tumors, for which no effective treatment was available before. Today, cancer research is always aimed at the study and development of new therapeutic approaches for cancer treatment. Currently, several researchers are focused on the development of cell therapies, anti-tumor vaccines, and new biotechnological drugs that have already shown promising results in preclinical studies, therefore, in the near future, we will certainly assist to a new revolution in the field of medical oncology.
Collapse
Affiliation(s)
- Luca Falzone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| |
Collapse
|
3529
|
Schmidts A, Maus MV. Making CAR T Cells a Solid Option for Solid Tumors. Front Immunol 2018; 9:2593. [PMID: 30467505 PMCID: PMC6235951 DOI: 10.3389/fimmu.2018.02593] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/22/2018] [Indexed: 01/02/2023] Open
Abstract
Adoptive cell therapy with chimeric antigen receptor (CAR) T cells aims to redirect the patient's own immune system to selectively attack cancer cells. To do so, CAR T cells are endowed with specific antigen recognition moieties fused to signaling and costimulatory domains. While this approach has shown great success for the treatment of B cell malignancies, response rates among patients with solid cancers are less favorable. The major challenges for CAR T cell immunotherapy in solid cancers are the identification of unique tumor target antigens, as well as improving CAR T cell trafficking to and expansion at the tumor site. This review focuses on combinatorial antigen targeting, regional delivery and approaches to improve CAR T cell persistence in the face of a hostile tumor microenvironment.
Collapse
Affiliation(s)
- Andrea Schmidts
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Marcela V Maus
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
3530
|
Hay KA. Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen receptor-modified (CAR-) T cell therapy. Br J Haematol 2018; 183:364-374. [PMID: 30407609 DOI: 10.1111/bjh.15644] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chimeric antigen receptor-modified (CAR)-T cells have demonstrated impressive results in the treatment of haematological malignancies. However, cytokine release syndrome (CRS) and neurotoxicity are common toxicities which are potentially life-threatening in severe cases. Risk factors for CRS and neurotoxicity identified so far include disease burden, lymphodepletion intensity and CAR-T cell dose administered. Risk-adapted dosing, with lower CAR-T cell doses administered to B-cell acute lymphoblastic leukaemia patients with high marrow blast counts, has been successful at decreasing severe CRS rates in this population. Intervention with therapies, such as tocilizumab and corticosteroids, have been effective at ameliorating toxicity, enabling CAR-T cells to be administered safely to many patients without significantly compromising efficacy. Deeper understanding of the pathophysiology of underlying CRS and neurotoxicity will enable the development of novel approaches to reduce toxicity and improve outcomes.
Collapse
Affiliation(s)
- Kevin A Hay
- Department of Medicine, University of British Columbia, Vancouver, BC, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
3531
|
Kaufmann P, Pariser AR, Austin C. From scientific discovery to treatments for rare diseases - the view from the National Center for Advancing Translational Sciences - Office of Rare Diseases Research. Orphanet J Rare Dis 2018; 13:196. [PMID: 30400963 PMCID: PMC6219030 DOI: 10.1186/s13023-018-0936-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
We now live in a time of unprecedented opportunities to turn scientific discoveries into better treatments for the estimated 30 million people in the US living with rare diseases. Despite these scientific advances, more than 90% of rare diseases still lack an effective treatment. New data and genetics technologies have resulted in the first transformational new treatments for a handful of rare diseases. This challenges us as a society to accelerate progress so that no disease and no patient is, ultimately, left behind in getting access to safe and effective therapeutics. This article reviews initiatives of the National Center for Advancing Translational Sciences (NCATS) Office of Rare Diseases Research (ORDR) that are aimed at catalyzing rare diseases research. These initiatives fall into two groups: Promoting information sharing; and building multi-disciplinary multi-stakeholder collaborations. Among ORDR’s information sharing initiatives are GARD (The Genetics and Rare Diseases Information Center), RaDaR (The Rare Diseases Registries Program) and the NCATS Toolkit for Patient-Focused Therapy Development (Toolkit). Among the collaboration initiatives are the RDCRN (Rare Diseases Clinical Research Network), and the NCATS ORDR support for conferences and workshops. Despite the success of these programs, there remains substantial work to be done to build enhanced collaborations, clinical harmonization and interoperability, and stakeholder engagement so that the recent scientific advances can benefit all patients on the long list of rare diseases waiting for help.
Collapse
Affiliation(s)
- Petra Kaufmann
- Avexis Inc. Formerly of Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | | |
Collapse
|
3532
|
Qin H, Ramakrishna S, Nguyen S, Fountaine TJ, Ponduri A, Stetler-Stevenson M, Yuan CM, Haso W, Shern JF, Shah NN, Fry TJ. Preclinical Development of Bivalent Chimeric Antigen Receptors Targeting Both CD19 and CD22. MOLECULAR THERAPY-ONCOLYTICS 2018; 11:127-137. [PMID: 30581986 PMCID: PMC6300726 DOI: 10.1016/j.omto.2018.10.006] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Abstract
Despite high remission rates following CAR-T cell therapy in B-ALL, relapse due to loss of the targeted antigen is increasingly recognized as a mechanism of immune escape. We hypothesized that simultaneous targeting of CD19 and CD22 may reduce the likelihood of antigen loss, thus improving sustained remission rates. A systematic approach to the generation of CAR constructs incorporating two target-binding domains led to several novel CD19/CD22 bivalent CAR constructs. Importantly, we demonstrate the challenges associated with the construction of a bivalent CAR format that preserves bifunctionality against both CD19 and CD22. Using the most active bivalent CAR constructs, we found similar transduction efficiency compared to that of either CD19 or CD22 single CARs alone. When expressed on human T cells, the optimized CD19/CD22 CAR construct induced comparable interferon γ and interleukin-2 in vitro compared to single CARs against dual-antigen-expressing as well as single-antigen-expressing cell lines. Finally, the T cells expressing CD19/CD22 CAR eradicated ALL cell line xenografts and patient-derived xenografts (PDX), including a PDX generated from a patient with CD19- relapse following CD19-directed CAR therapy. The CD19/CD22 bivalent CAR provides an opportunity to test whether simultaneous targeting may reduce risk of antigen loss.
Collapse
Affiliation(s)
- Haiying Qin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sneha Ramakrishna
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sang Nguyen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Thomas J Fountaine
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Anusha Ponduri
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | | | - Constance M Yuan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Waleed Haso
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Jack F Shern
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Terry J Fry
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
3533
|
Baumeister SH, Murad J, Werner L, Daley H, Trebeden-Negre H, Gicobi JK, Schmucker A, Reder J, Sentman CL, Gilham DE, Lehmann FF, Galinsky I, DiPietro H, Cummings K, Munshi NC, Stone RM, Neuberg DS, Soiffer R, Dranoff G, Ritz J, Nikiforow S. Phase I Trial of Autologous CAR T Cells Targeting NKG2D Ligands in Patients with AML/MDS and Multiple Myeloma. Cancer Immunol Res 2018; 7:100-112. [PMID: 30396908 DOI: 10.1158/2326-6066.cir-18-0307] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/02/2018] [Accepted: 10/29/2018] [Indexed: 11/16/2022]
Abstract
NKG2D ligands are widely expressed in solid and hematologic malignancies but absent or poorly expressed on healthy tissues. We conducted a phase I dose-escalation study to evaluate the safety and feasibility of a single infusion of NKG2D-chimeric antigen receptor (CAR) T cells, without lymphodepleting conditioning in subjects with acute myeloid leukemia/myelodysplastic syndrome or relapsed/refractory multiple myeloma. Autologous T cells were transfected with a γ-retroviral vector encoding a CAR fusing human NKG2D with the CD3ζ signaling domain. Four dose levels (1 × 106-3 × 107 total viable T cells) were evaluated. Twelve subjects were infused [7 acute myeloid leukemia (AML) and 5 multiple myeloma]. NKG2D-CAR products demonstrated a median 75% vector-driven NKG2D expression on CD3+ T cells. No dose-limiting toxicities, cytokine release syndrome, or CAR T cell-related neurotoxicity was observed. No significant autoimmune reactions were noted, and none of the ≥ grade 3 adverse events were attributable to NKG2D-CAR T cells. At the single injection of low cell doses used in this trial, no objective tumor responses were observed. However, hematologic parameters transiently improved in one subject with AML at the highest dose, and cases of disease stability without further therapy or on subsequent treatments were noted. At 24 hours, the cytokine RANTES increased a median of 1.9-fold among all subjects and 5.8-fold among six AML patients. Consistent with preclinical studies, NKG2D-CAR T cell-expansion and persistence were limited. Manufactured NKG2D-CAR T cells exhibited functional activity against autologous tumor cells in vitro, but modifications to enhance CAR T-cell expansion and target density may be needed to boost clinical activity.
Collapse
Affiliation(s)
- Susanne H Baumeister
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology-Oncology Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joana Murad
- Celdara Medical, LLC, Lebanon, New Hampshire
| | - Lillian Werner
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Daley
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Helene Trebeden-Negre
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joanina K Gicobi
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jake Reder
- Celdara Medical, LLC, Lebanon, New Hampshire
| | | | | | | | - Ilene Galinsky
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heidi DiPietro
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristen Cummings
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nikhil C Munshi
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Richard M Stone
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Donna S Neuberg
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Glenn Dranoff
- Novartis BioMedical Institutes, Cambridge, Massachusetts
| | - Jerome Ritz
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarah Nikiforow
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts. .,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3534
|
Harnessing the immune system in glioblastoma. Br J Cancer 2018; 119:1171-1181. [PMID: 30393372 PMCID: PMC6251037 DOI: 10.1038/s41416-018-0258-8] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma is the most common primary malignant brain tumour. Survival is poor and improved treatment options are urgently needed. Although immunotherapies have emerged as effective treatments for a number of cancers, translation of these through to brain tumours is a distinct challenge, particularly due to the blood-brain barrier and the unique immune tumour microenvironment afforded by CNS-specific cells. This review discusses the immune system within the CNS, mechanisms of immune escape employed by glioblastoma, and the immunological effects of conventional glioblastoma treatments. Novel therapies for glioblastoma that harness the immune system and their current clinical progress are outlined, including cancer vaccines, T-cell therapies and immune checkpoint modulators.
Collapse
|
3535
|
Divining T-cell targets for cancer immunotherapy. Blood 2018; 132:1861-1863. [PMID: 30385487 DOI: 10.1182/blood-2018-09-873588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
3536
|
Alcantara M, Tesio M, June CH, Houot R. CAR T-cells for T-cell malignancies: challenges in distinguishing between therapeutic, normal, and neoplastic T-cells. Leukemia 2018; 32. [PMID: 30315238 PMCID: PMC7433349 DOI: 10.1038/s41375-018-0285-8 10.1038/s41375-018-0285-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chimeric antigen receptor (CAR) T-cells targeting CD19 demonstrated remarkable efficacy for the treatment of B-cell malignancies. The development of CAR T-cells against T-cell malignancies appears more challenging due to the similarities between the therapeutic, normal and malignant T-cells. The obstacles include CAR T-cell fratricide, T-cell aplasia, and contamination of CAR T-cell products with malignant T-cells. Here, we review these challenges and propose solutions to overcome these limitations.
Collapse
Affiliation(s)
- Marion Alcantara
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France,Institut Necker Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - Melania Tesio
- Institut Necker Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - Carl H. June
- Center for Cellular Immunotherapies, Perlman School of Medicine, Philadelphia, PA, USA,Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA, USA,Department of Pathology and Laboratory Medicine, Perlman School of Medicine, Philadelphia, PA, USA
| | - Roch Houot
- CHU Rennes, Service Hématologie Clinique, 35033 Rennes, France,INSERM, U1236, 35043 Rennes, France,INSERM 0203, Unité d’Investigation Clinique, 35033 Rennes, France
| |
Collapse
|
3537
|
Perica K, Palomba L, Brentjens RJ. Dawn of Chimeric Antigen Receptor T Cell Therapy in Non-Hodgkin Lymphoma. ACTA ACUST UNITED AC 2018; 1. [PMID: 33043278 DOI: 10.1002/acg2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Two Chimeric Antigen Receptor (CAR) T cell therapies are now approved for the treatment of relapsed and refractory large cell lymphomas, with many others under development. The dawn of CAR T cell therapy in non-Hodgkin Lymphoma (NHL) has been characterized by rapid progress and high response rates, with a subset of patients experiencing durable benefit. In this review, we describe commercially available and investigational CAR T cell therapies, including product characteristics and clinical outcomes. We review patient selection, with an emphasis on sequencing cell therapy options in the refractory setting. Finally, we discuss durability of response, highlighting mechanisms of escape and investigational approaches to prevent and treat relapse after CAR T cell therapy.
Collapse
Affiliation(s)
- Karlo Perica
- Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, N.Y, U.S.A
| | - Lia Palomba
- Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, N.Y, U.S.A.,Cellular Therapeutics Center; Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, N.Y, U.S.A
| | - Renier J Brentjens
- Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, N.Y, U.S.A.,Cellular Therapeutics Center; Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, N.Y, U.S.A
| |
Collapse
|
3538
|
Advani R, Flinn I, Popplewell L, Forero A, Bartlett NL, Ghosh N, Kline J, Roschewski M, LaCasce A, Collins GP, Tran T, Lynn J, Chen JY, Volkmer JP, Agoram B, Huang J, Majeti R, Weissman IL, Takimoto CH, Chao MP, Smith SM. CD47 Blockade by Hu5F9-G4 and Rituximab in Non-Hodgkin's Lymphoma. N Engl J Med 2018; 379:1711-1721. [PMID: 30380386 PMCID: PMC8058634 DOI: 10.1056/nejmoa1807315] [Citation(s) in RCA: 754] [Impact Index Per Article: 125.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Hu5F9-G4 (hereafter, 5F9) antibody is a macrophage immune checkpoint inhibitor blocking CD47 that induces tumor-cell phagocytosis. 5F9 synergizes with rituximab to eliminate B-cell non-Hodgkin's lymphoma cells by enhancing macrophage-mediated antibody-dependent cellular phagocytosis. This combination was evaluated clinically. METHODS We conducted a phase 1b study involving patients with relapsed or refractory non-Hodgkin's lymphoma. Patients may have had diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma. 5F9 (at a priming dose of 1 mg per kilogram of body weight, administered intravenously, with weekly maintenance doses of 10 to 30 mg per kilogram) was given with rituximab to determine safety and efficacy and to suggest a phase 2 dose. RESULTS A total of 22 patients (15 with DLBCL and 7 with follicular lymphoma) were enrolled. Patients had received a median of 4 (range, 2 to 10) previous therapies, and 95% of the patients had disease that was refractory to rituximab. Adverse events were predominantly of grade 1 or 2. The most common adverse events were anemia and infusion-related reactions. Anemia (an expected on-target effect) was mitigated by the strategy of 5F9 prime and maintenance dosing. Dose-limiting side effects were rare. A selected phase 2 dose of 30 mg of 5F9 per kilogram led to an approximate 100% CD47-receptor occupancy on circulating white and red cells. A total of 50% of the patients had an objective (i.e., complete or partial) response, with 36% having a complete response. The rates of objective response and complete response were 40% and 33%, respectively, among patients with DLBCL and 71% and 43%, respectively, among those with follicular lymphoma. At a median follow-up of 6.2 months among patients with DLBCL and 8.1 months among those with follicular lymphoma, 91% of the responses were ongoing. CONCLUSIONS The macrophage checkpoint inhibitor 5F9 combined with rituximab showed promising activity in patients with aggressive and indolent lymphoma. No clinically significant safety events were observed in this initial study. (Funded by Forty Seven and the Leukemia and Lymphoma Society; ClinicalTrials.gov number, NCT02953509 .).
Collapse
Affiliation(s)
- Ranjana Advani
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Ian Flinn
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Leslie Popplewell
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Andres Forero
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Nancy L Bartlett
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Nilanjan Ghosh
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Justin Kline
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Mark Roschewski
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Ann LaCasce
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Graham P Collins
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Thu Tran
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Judith Lynn
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - James Y Chen
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Jens-Peter Volkmer
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Balaji Agoram
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Jie Huang
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Ravindra Majeti
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Irving L Weissman
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Chris H Takimoto
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Mark P Chao
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| | - Sonali M Smith
- From Stanford University, Stanford (R.A., T.T., R.M., I.L.W.), City of Hope, Duarte (L.P.), and Forty Seven, Menlo Park (J.L., J.Y.C., J.-P.V., B.A., J.H., R.M., I.L.W., C.H.T., M.P.C.) - all in California; Sarah Cannon Research Institute-Tennessee Oncology, Nashville (I.F.); University of Alabama at Birmingham, Birmingham (A.F.); Washington University in St. Louis, St. Louis (N.L.B.); Levine Cancer Institute-Atrium Health, Charlotte, NC (N.G.); University of Chicago, Chicago (J.K., S.M.S.); National Cancer Institute, Rockville, MD (M.R.); Dana-Farber Cancer Institute, Boston (A.L.); and University of Oxford, Oxford, United Kingdom (G.P.C.)
| |
Collapse
|
3539
|
Puronen CE, Cassaday RD, Stevenson PA, Sandmaier BM, Flowers ME, Green DJ, Maloney DG, Storb RF, Press OW, Gopal AK. Long-Term Follow-Up of 90Y-Ibritumomab Tiuxetan, Fludarabine, and Total Body Irradiation-Based Nonmyeloablative Allogeneic Transplant Conditioning for Persistent High-Risk B Cell Lymphoma. Biol Blood Marrow Transplant 2018; 24:2211-2215. [PMID: 30454872 PMCID: PMC6251312 DOI: 10.1016/j.bbmt.2018.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) can provide prolonged remissions in patients with advanced B cell lymphoma (B-NHL) via the graft-versus-lymphoma effect, although inferior results are seen in patients with chemoresistant, bulky, or aggressive disease. Radioimmunotherapy can safely induce responses in B-NHL with minimal nonhematologic toxicity. Initial results of 90Y-ibritumomab tiuxetan-based allografting demonstrated early safety and disease control in nonremission patients but with short follow-up. Here we report the long-term outcomes of patients treated on this study with specific emphasis on patients achieving early remissions. Eleven of 40 patients were alive at a median follow-up of 9 years (range, 5.3 to 10.2). Fourteen (35%) deaths were due to disease progression and 14 (35%) deaths to complications from HCT. One patient died of a Merkel cell carcinoma. The 5-year overall and progression-free survival for patients with indolent B-NHL was 40% and 27.5%, respectively. None of the patients with diffuse large B cell lymphoma was a long-term disease-free survivor regardless of early remission status. 90Y-ibritumomab tiuxetan-based allografting represents a viable option in patients with indolent histologies. Improved strategies are needed for aggressive B-NHL. The original trial was registered at www.clinicaltrials.gov as NCT00119392.
Collapse
Affiliation(s)
- Camille E Puronen
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ryan D Cassaday
- Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Philip A Stevenson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Brenda M Sandmaier
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E Flowers
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Damian J Green
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David G Maloney
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rainer F Storb
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Oliver W Press
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ajay K Gopal
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| |
Collapse
|
3540
|
T lymphocytes as therapeutic arsenal for patients with hematological malignancies. Curr Opin Oncol 2018; 30:425-434. [DOI: 10.1097/cco.0000000000000481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
3541
|
Switchable control over in vivo CAR T expansion, B cell depletion, and induction of memory. Proc Natl Acad Sci U S A 2018; 115:E10898-E10906. [PMID: 30373813 PMCID: PMC6243241 DOI: 10.1073/pnas.1810060115] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy represents a powerful strategy in immuno-oncology. Nevertheless, associated life-threatening toxicities and chronic B cell aplasia have underscored the need to control engineered T cells in the patient. To address these challenges, we have previously developed a switchable CAR (sCAR) T cell platform that allows dose-titratable control over CAR T cell activity by using antibody-based switches. Here, we demonstrate in a syngeneic murine model that the switchable platform can impart antitumor efficacy while dissociating long-term persistence from chronic B cell aplasia. Further, the functional reversibility of the switchable platform can be leveraged to incorporate “rest” phases through cyclical dosing of the switch to enable the induction of a robust central memory population for in vivo, on-demand expansion of sCAR T cells. Chimeric antigen receptor (CAR) T cells with a long-lived memory phenotype are correlated with durable, complete remissions in patients with leukemia. However, not all CAR T cell products form robust memory populations, and those that do can induce chronic B cell aplasia in patients. To address these challenges, we previously developed a switchable CAR (sCAR) T cell system that allows fully tunable, on/off control over engineered cellular activity. To further evaluate the platform, we generated and assessed different murine sCAR constructs to determine the factors that afford efficacy, persistence, and expansion of sCAR T cells in a competent immune system. We find that sCAR T cells undergo significant in vivo expansion, which is correlated with potent antitumor efficacy. Most importantly, we show that the switch dosing regimen not only allows control over B cell populations through iterative depletion and repopulation, but that the “rest” period between dosing cycles is the key for induction of memory and expansion of sCAR T cells. These findings introduce rest as a paradigm in enhancing memory and improving the efficacy and persistence of engineered T cell products.
Collapse
|
3542
|
Tariq SM, Haider SA, Hasan M, Tahir A, Khan M, Rehan A, Kamal A. Chimeric Antigen Receptor T-Cell Therapy: A Beacon of Hope in the Fight Against Cancer. Cureus 2018; 10:e3486. [PMID: 30613448 PMCID: PMC6314790 DOI: 10.7759/cureus.3486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Despite significant advancements, relapses, and persistent malignancies are still a major challenge faced by the oncologists. Immunotherapy has shown remarkable potential in induction of sustained remission in refractory malignancies. Chimeric antigen receptor T-cell (CAR-T) therapy is a newer treatment methodology approved by the Food and Drug Administration (FDA). The chimeric pairing of an antigen receptor with the T-cell receptor (TCR) intracellular signaling domain allows cluster of designation 8 (CD8) cytotoxic T-cells to target cell surface makers independent of major histocompatibility complex (MHC) activation. Another essential feature which contributes to the broad applicability of CARs and expanding their potential targets is their ability to bind not only to proteins but also to carbohydrate and glycolipid structures. Their antigen-specific and targeted immune responses have shown promising outcomes in clinical trials particularly involving B-cell malignancies and solid tumors. High remission rates and low percentages of relapses have caused a paradigm shift in the treatment of relapsed or refractory cancers. Challenges include side effects such as cytokine release syndrome, on-target off-tumor toxicities, and replication of its success in treating solid tumors. The burden of side effects and hefty cost of treatment are major obstacles which could hinder its progress globally. Nevertheless, ongoing research would only result in a maximized therapeutic potential in addition to more patient- and cost-friendly treatment. In this review, we aim to provide the readers an overview of chimeric antigen receptor T-cell therapy, a relatively new advancement in the world of immuno-oncology and thereby also discussing its advantages, side effects and future challenges.
Collapse
Affiliation(s)
- Syed Maaz Tariq
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Syed Ali Haider
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Mohammad Hasan
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Amber Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maria Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Arisha Rehan
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Anum Kamal
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| |
Collapse
|
3543
|
Guedan S, Alemany R. CAR-T Cells and Oncolytic Viruses: Joining Forces to Overcome the Solid Tumor Challenge. Front Immunol 2018; 9:2460. [PMID: 30405639 PMCID: PMC6207052 DOI: 10.3389/fimmu.2018.02460] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/04/2018] [Indexed: 12/28/2022] Open
Abstract
Adoptive transfer of chimeric antigen receptor (CAR)-modified T cells has resulted in unprecedented rates of long-lasting complete responses in patients with leukemia and lymphoma. However, despite the impressive results in patients with hematologic malignancies, CAR-T cells have showed limited effect against solid cancers. New approaches will need to simultaneously overcome the multiple challenges that CAR-T cells encounter in solid tumors, including the immunosuppressive tumor microenvironment and heterogeneity of antigen expression. Oncolytic viruses are lytic and immunogenic anti-cancer agents with the potential to synergize with CAR-T cells for the treatment of solid tumors. In addition, viruses can be further modified to deliver therapeutic transgenes selectively to the tumor microenvironment, which could enhance the effector functions of tumor-specific T cells. This review summarizes the major limitations of CAR-T cells in solid tumors and discusses the potential role for oncolytic viruses as partners for CAR-T cells in the fight against cancer.
Collapse
Affiliation(s)
- Sonia Guedan
- Department of Hematology and Oncology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ramon Alemany
- ProCure Program, IDIBELL-Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Spain
| |
Collapse
|
3544
|
Subbiah V, Kurzrock R. The Marriage Between Genomics and Immunotherapy: Mismatch Meets Its Match. Oncologist 2018; 24:1-3. [PMID: 30352943 PMCID: PMC6324623 DOI: 10.1634/theoncologist.2017-0519] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 08/31/2018] [Indexed: 01/05/2023] Open
Abstract
This commentary evaluates the immune‐genomic connection.
Collapse
Affiliation(s)
- Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, Unit 0455, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Razelle Kurzrock
- Division of Hematology & Oncology, Center for Personalized Therapy & Clinical Trials Office, UC San Diego - Moores Cancer Center, La Jolla California, USA
| |
Collapse
|
3545
|
Frank AM, Buchholz CJ. Surface-Engineered Lentiviral Vectors for Selective Gene Transfer into Subtypes of Lymphocytes. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2018; 12:19-31. [PMID: 30417026 PMCID: PMC6216101 DOI: 10.1016/j.omtm.2018.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lymphocytes have always been among the prime targets in gene therapy, even more so since chimeric antigen receptor (CAR) T cells have reached the clinic. However, other gene therapeutic approaches hold great promise as well. The first part of this review provides an overview of current strategies in lymphocyte gene therapy. The second part highlights the importance of precise gene delivery into B and T cells as well as distinct subtypes of lymphocytes. This can be achieved with lentiviral vectors (LVs) pseudotyped with engineered glycoproteins recognizing lymphocyte surface markers as entry receptors. Different strategies for envelope glycoprotein engineering and selection of the targeting ligand are discussed. With a CD8-targeted LV that was recently used to achieve proof of principle for the in vivo reprogramming of CAR T cells, these vectors are becoming a key tool to genetically engineer lymphocytes directly in vivo.
Collapse
Affiliation(s)
- Annika M Frank
- Division of Medical Biotechnology, Paul-Ehrlich-Institut, 63225 Langen, Germany
| | - Christian J Buchholz
- Division of Medical Biotechnology, Paul-Ehrlich-Institut, 63225 Langen, Germany.,Molecular Biotechnology and Gene Therapy, Paul-Ehrlich-Institut, 63225 Langen, Germany
| |
Collapse
|
3546
|
CAR T-cells for T-cell malignancies: challenges in distinguishing between therapeutic, normal, and neoplastic T-cells. Leukemia 2018; 32:2307-2315. [PMID: 30315238 DOI: 10.1038/s41375-018-0285-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/24/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022]
Abstract
Chimeric antigen receptor (CAR) T-cells targeting CD19 demonstrated remarkable efficacy for the treatment of B-cell malignancies. The development of CAR T-cells against T-cell malignancies appears more challenging due to the similarities between the therapeutic, normal and malignant T-cells. The obstacles include CAR T-cell fratricide, T-cell aplasia, and contamination of CAR T-cell products with malignant T-cells. Here, we review these challenges and propose solutions to overcome these limitations.
Collapse
|
3547
|
Rotolo A, Caputo VS, Holubova M, Baxan N, Dubois O, Chaudhry MS, Xiao X, Goudevenou K, Pitcher DS, Petevi K, Kachramanoglou C, Iles S, Naresh K, Maher J, Karadimitris A. Enhanced Anti-lymphoma Activity of CAR19-iNKT Cells Underpinned by Dual CD19 and CD1d Targeting. Cancer Cell 2018; 34:596-610.e11. [PMID: 30300581 PMCID: PMC6179961 DOI: 10.1016/j.ccell.2018.08.017] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/18/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
Chimeric antigen receptor anti-CD19 (CAR19)-T cell immunotherapy-induced clinical remissions in CD19+ B cell lymphomas are often short lived. We tested whether CAR19-engineering of the CD1d-restricted invariant natural killer T (iNKT) cells would result in enhanced anti-lymphoma activity. CAR19-iNKT cells co-operatively activated by CD1d- and CAR19-CD19-dependent interactions are more effective than CAR19-T cells against CD1d-expressing lymphomas in vitro and in vivo. The swifter in vivo anti-lymphoma activity of CAR19-iNKT cells and their enhanced ability to eradicate brain lymphomas underpinned an improved tumor-free and overall survival. CD1D transcriptional de-repression by all-trans retinoic acid results in further enhanced cytotoxicity of CAR19-iNKT cells against CD19+ chronic lymphocytic leukemia cells. Thus, iNKT cells are a highly efficient platform for CAR-based immunotherapy of lymphomas and possibly other CD1d-expressing cancers.
Collapse
MESH Headings
- Animals
- Antigens, CD19/genetics
- Antigens, CD19/immunology
- Antigens, CD1d/genetics
- Antigens, CD1d/immunology
- Cell- and Tissue-Based Therapy
- Humans
- Immunotherapy/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma/drug therapy
- Lymphoma/immunology
- Mice
- Natural Killer T-Cells/cytology
- Natural Killer T-Cells/immunology
Collapse
Affiliation(s)
- Antonia Rotolo
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - Valentina S Caputo
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - Monika Holubova
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK; Biomedical Center, Medical Faculty in Pilsen, Charles University, Alej Svobody 76, Pilsen 323 00, Czech Republic
| | - Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London, UK
| | - Olivier Dubois
- Biological Imaging Centre, Department of Medicine, Imperial College London, London, UK
| | | | - Xiaolin Xiao
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - Katerina Goudevenou
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - David S Pitcher
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - Kyriaki Petevi
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | | | - Sandra Iles
- Cellular Pathology, Hammersmith Hospital, Northwest London Pathology, London, UK
| | - Kikkeri Naresh
- Centre for Haematology, Department of Medicine, Imperial College London, London, UK
| | - John Maher
- King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Hospital, London, UK
| | | |
Collapse
|
3548
|
Zhang W, Jordan KR, Schulte B, Purev E. Characterization of clinical grade CD19 chimeric antigen receptor T cells produced using automated CliniMACS Prodigy system. Drug Des Devel Ther 2018; 12:3343-3356. [PMID: 30323566 PMCID: PMC6181073 DOI: 10.2147/dddt.s175113] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cell therapy is highly effective for treating acute lymphoblastic leukemia and non-Hodgkin's lymphoma with high rate complete responses. However, the broad clinical application of CAR T-cell therapy has been challenging, largely due to the lack of widespread ability to produce and high cost of CAR T-cell products using traditional methods of production. Automated cell processing in a closed system has emerged as a potential method to increase the feasibility of producing CAR T cells locally at academic centers due to its minimal reliance on experienced labor, thereby making the process less expensive and more consistent than traditional methods of production. METHOD In this study, we describe the successful production of clinical grade CD19 CAR T cells using the Miltenyi CliniMACS Prodigy Automated Cell Processor at University of Colorado Anschutz Medical Campus in a rapid manner with a high frequent CD19 CAR expression. RESULTS The final CAR T-cell product is highly active, low in immune suppression, and absent in exhaustion. Full panel cytokine assays also showed elevated production of Th1 cytokines upon IL-2 stimulation when specifically killing CD19+ target cells. CONCLUSION These results demonstrate the feasibility of producing CAR T cells locally in a university hospital setting using automated cell processor for future clinical applications.
Collapse
Affiliation(s)
- Wei Zhang
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,
| | - Kimberly R Jordan
- Division of Immunology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Brian Schulte
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Enkhtsetseg Purev
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,
| |
Collapse
|
3549
|
Abstract
Despite significant progress in our understanding and the development of novel therapies, most patients with multiple myeloma will experience relapse of their disease. Therapy of relapsed myeloma has improved due to the availability of novel agents that are highly active against the disease. However, the selection of therapy can be challenging due to the emergence of toxicities, comorbidities and frailty. In the following we discuss our approach to the treatment of the patient with relapsed myeloma.
Collapse
Affiliation(s)
- Mohammed A Aljama
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Hasib Sidiqi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA -
| |
Collapse
|
3550
|
Gomes-Silva D, Atilla E, Atilla PA, Mo F, Tashiro H, Srinivasan M, Lulla P, Rouce RH, Cabral JMS, Ramos CA, Brenner MK, Mamonkin M. CD7 CAR T Cells for the Therapy of Acute Myeloid Leukemia. Mol Ther 2018; 27:272-280. [PMID: 30391141 DOI: 10.1016/j.ymthe.2018.10.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy for the treatment of acute myeloid leukemia (AML) has the risk of toxicity to normal myeloid cells. CD7 is expressed by the leukemic blasts and malignant progenitor cells of approximately 30% of AML patients but is absent on normal myeloid and erythroid cells. Since CD7 expression by malignant blasts is also linked with chemoresistance and poor outcomes, targeting this antigen may be beneficial for this subset of AML patients. Here, we show that expression of a CD7-directed CAR in CD7 gene-edited (CD7KO) T cells effectively eliminates CD7+ AML cell lines, primary CD7+ AML, and colony-forming cells but spares myeloid and erythroid progenitor cells and their progeny. In a xenograft model, CD7 CAR T cells protect mice against systemic leukemia, prolonging survival. Our results support the feasibility of using CD7KO CD7 CAR T cells for the non-myeloablative treatment of CD7+ AML.
Collapse
Affiliation(s)
- Diogo Gomes-Silva
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Bioengineering and Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Erden Atilla
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Pinar Ataca Atilla
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Feiyan Mo
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA; Interdepartmental Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Haruko Tashiro
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Madhuwanti Srinivasan
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Premal Lulla
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rayne H Rouce
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joaquim M S Cabral
- Department of Bioengineering and Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos A Ramos
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Malcolm K Brenner
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maksim Mamonkin
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, TX 77030, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA.
| |
Collapse
|