Adoptive transfer of autologous tumor-infiltrating lymphocytes in metastatic human papilloma virus-induced carcinoma (VAC7P.1040)

Given the constitutive tumor-specific expression of high risk human papilloma virus (HPV) E6 and E7 oncoproteins in HPV+ carcinomas, we evaluated whether adoptive transfer of autologous tumor-infiltrating lymphocytes (TIL) selected for HPV E6/E7 reactivity could mediate regression of metastatic HPV+ carcinomas. TIL were selected preferentially for HPV E6/E7 peptide pool reactivity, when possible. Patients received a single TIL infusion and interleukin-2 to tolerance after non-myeloablative chemotherapy. The treatment regimen led to objective clinical responses in 6/23 patients, including 4/15 cervical cancer, 1/5 anal cancer and 1/3 head and neck cancer patients. Two complete responses occured in cervical carcinoma that are ongoing 20 and 26 months after treatment. The other four responses were partial, three lasted from 3 to 5 months, and one is ongoing at 3 months. The frequency of HPV reactive T cells in the TIL infusion of 17 patients analyzed thus far (including five with a clinical response), as measured by IFNg ELISPOT and CD137 upregulation, correlated with clinical response (P=0.0238 and P=0.0485). In addition, the magnitude of HPV reactivity as measured by IFNg production correlated with clinical response (P=0.0003). Regression of metastatic HPV+ carcinomas can occur after TIL therapy in some patients. Exploratory studies suggest a correlation between HPV reactivity of the infusion product and clinical response.

HPV-targeted tumor-infiltrating lymphocytes for cervical cancer

LBA3008

Background: Adoptive T-cell therapy (ACT) is a promising cancer treatment modality with potentially broad application. It is not known if ACT can mediate regression of carcinomas, the most common solid tumors in humans. We studied carcinoma of the uterine cervix, a virally induced malignancy that constitutively expresses the HPV E6 and E7 oncoproteins, as a model cancer to test if ACT can mediate regression of an epithelial malignancy. Methods: We initiated a clinical trial to treat metastatic HPV+ cancers with tumor-infiltrating lymphocytes (TIL) selected for HPV E6- and E7-reactivity (HPV-TIL). Patients from the cervical cancer cohort are reported here. HPV-TIL infusion was preceded b y non-myeloablative conditioning and followed by high-dose bolus aldesleukin. HPV-reactivity was assessed by ELISPOT, IFN-gamma production, and CD137 expression assays. Results: Nine patients were treated on the study. They received a median of 81 x 109 T cells (range 33 to 159 x 109) as a single infusion. The infused cells possessed reactivity against high-risk HPV E6 and/or E7 in 6/8 patients. The two patients with no HPV reactivity did not respond to treatment. 3/6 patients with HPV reactivity demonstrated objective tumor responses by RECIST (1 PR and 2 CR). One patient had a 39% best response. Two patients with widespread metastases had complete tumor responses that are ongoing 18 and 11 months after treatment. One patient with a complete response had a chemotherapy-refractory HPV-16+ squamous cell carcinoma and the other a chemoradiation-refractory HPV-18+ adenocarcinoma. Both patients demonstrated prolonged repopulation with HPV-reactive T cells following treatment. Increased frequencies of HPV-specific T cells were detectable after 13 months in one patient and 6 months in the other. Two patients with HPV-reactive TIL that did not respond to treatment did not display repopulation with HPV-reactive T cells. Conclusions: HPV-TIL can mediate durable, complete regression of metastatic cervical cancer. Continued investigation of HPV-TIL for cervical cancer, and possibly other HPV+ malignancies, is warranted. Cellular therapy can mediate complete regression of an epithelial malignancy. Clinical trial information: NCT01585428.

The highs and lows of my political career

Dr. Lewis Draper represented a rural Saskatchewan riding in the provincial legislature from 1991 to 1995. In this article he muses on the highs and lows of his career in politics.