<p>T cell therapy has proven challenging for pancreatic ductal adenocarcinoma (PDAC), partly due to heterogeneous expression of tumor-associated antigens (TAAs). To address tumor heterogeneity and mitigate immune evasion, an ex vivo expanded, polyclonal, T helper 1 cell-polarized T cell product targeting five TAAs—PRAME, SSX2, MAGEA4, Survivin and NY-ESO-1—was developed. These antigens were chosen based on their tumor specificity, oncogenicity, immunogenicity and level of expression. In a phase 1/2 trial, this autologous nonengineered T cell product was administered (1 × 10<sup>7</sup> cells m<sup>−2</sup> per infusion) monthly to patients with advanced PDAC responding (arm A, <i>n</i> = 13) or refractory (arm B, <i>n</i> = 12) to first-line chemotherapy or with resectable disease (arm C, <i>n</i> = 12). Primary endpoints were safety and feasibility of completing six infusions, whereas exploratory efficacy endpoints included persistence and evaluating the relationship between clinical benefit and the expansion of the infused effector T cells, as well as the induction of de novo immune responses. Of 56 participants procured, 37 were infused, with only 1 treatment-related serious adverse event. Disease control rates in arms A and B were 84.6% (95% confidence interval: 54.6–98.1%) and 25% (95% confidence interval: 5.5–57.2%), respectively. In arm C, two of nine resected participants remained disease free after 66 months of follow-up. The infused cells persisted up to 12 months posttreatment and elevated levels of tumor-directed T cells were detected during dosing (<i>P</i> = 0.027) and follow-up in responders compared to nonresponders. Clinical outcomes correlated with peripheral expansion of functional TAA-targeted T cell clones and treatment-emergent antigen spreading. Thus, further investigation of this approach, either as a single agent or combined with other complementary modalities, is warranted (ClinicalTrials.gov identifier: <a href="https://clinicaltrials.gov/ct2/show/NCT03690193?term=NCT03192462">NCT03192462</a>).</p>

错误:搜索内容不能为空,请输入英文关键词
错误:关键词超出字数限制,请精简
高级检索

Autologous multiantigen-targeted T cell therapy for pancreatic cancer: a phase 1/2 trial

  • Benjamin L. Musher,
  • Spyridoula Vasileiou,
  • Brandon G. Smaglo,
  • Catherine S. Robertson,
  • Mengfen Wu,
  • Tao Wang,
  • Ayumi Watanabe,
  • Manik Kuvalekar,
  • Yovana Velazquez,
  • Shamika Ketkar,
  • Tamadar Al Doheyan,
  • Penelope G. Papayanni,
  • Aakash Shah,
  • Natalia Lapteva,
  • Bambi J. Grilley,
  • George Van Buren,
  • Premal D. Lulla,
  • Helen E. Heslop,
  • Cliona M. Rooney,
  • Malcolm K. Brenner,
  • Ann M. Leen

摘要

T cell therapy has proven challenging for pancreatic ductal adenocarcinoma (PDAC), partly due to heterogeneous expression of tumor-associated antigens (TAAs). To address tumor heterogeneity and mitigate immune evasion, an ex vivo expanded, polyclonal, T helper 1 cell-polarized T cell product targeting five TAAs—PRAME, SSX2, MAGEA4, Survivin and NY-ESO-1—was developed. These antigens were chosen based on their tumor specificity, oncogenicity, immunogenicity and level of expression. In a phase 1/2 trial, this autologous nonengineered T cell product was administered (1 × 107 cells m−2 per infusion) monthly to patients with advanced PDAC responding (arm A, n = 13) or refractory (arm B, n = 12) to first-line chemotherapy or with resectable disease (arm C, n = 12). Primary endpoints were safety and feasibility of completing six infusions, whereas exploratory efficacy endpoints included persistence and evaluating the relationship between clinical benefit and the expansion of the infused effector T cells, as well as the induction of de novo immune responses. Of 56 participants procured, 37 were infused, with only 1 treatment-related serious adverse event. Disease control rates in arms A and B were 84.6% (95% confidence interval: 54.6–98.1%) and 25% (95% confidence interval: 5.5–57.2%), respectively. In arm C, two of nine resected participants remained disease free after 66 months of follow-up. The infused cells persisted up to 12 months posttreatment and elevated levels of tumor-directed T cells were detected during dosing (P = 0.027) and follow-up in responders compared to nonresponders. Clinical outcomes correlated with peripheral expansion of functional TAA-targeted T cell clones and treatment-emergent antigen spreading. Thus, further investigation of this approach, either as a single agent or combined with other complementary modalities, is warranted (ClinicalTrials.gov identifier: NCT03192462).