Τρίτη, 29 Μαρτίου 2016

CAR-T CELLS FOR SOLID TUMOURS

Adding a genetically engineered “switch receptor” to second-generation CAR T cells blocked PD-1–mediated immune suppression, and made the immunotherapy effective against solid tumors in preclinical models, according to a study published by Liu et al in Cancer Research.
“Many cancers are still without optimal treatment options and are associated with great disease burden. This is especially true for [solid tumors],” said Edmund Moon, MD, Assistant Professor of Medicine in the Division of Pulmonary, Allergy, and Critical Care at the Perelman School of Medicine at the University of Pennsylvania.
“Immunotherapy…has shown great promise,” he said, adding that CAR T-cell therapy has demonstrated success in blood cancers.
“There is a large effort to expand the use of CAR T cells to solid tumors,” Dr. Moon said.
Many of the drawbacks with using CAR T cells to treat solid tumors are related to the much harsher tumor microenvironment in solid tumors as opposed to blood cancers, he explained.
“Our goal was to investigate ways in which CAR T cells can overcome one of the main defense mechanisms put up by the tumor microenvironment of solid tumors to shut down T cells: checkpoint inhibitory receptors. The specific inhibitory receptor dealt with in this study was programmed death-1, or PD-1,” Dr. Moon said.
Study Details
In this study, using human T cells, Dr. Moon and colleagues engineered second-generation CAR T cells that target specific proteins present on cancer cells (CD19, mesothelin, or PSCA), and using special viruses, inserted a genetically engineered switch receptor, PD1CD28, into the CAR T cells.
The researchers engineered the PD1CD28 switch receptor by combining parts of two proteins: the extracellular portion of PD-1 protein that recognizes the PD-L1 protein on tumors and the transmembrane and intracellular portion of CD28, a molecule naturally present in T cells that leads to heightened immune activity and immune cell proliferation.
Through laboratory experiments, they confirmed that the PD1CD28 switch receptor of the engineered CAR T cells was able to convert the immune-inhibitory signals induced by PD-L1 into immune-stimulatory signals, which caused tumor cell-killing.
Next, they compared the tumor cell-killing ability of the PD1CD28 CAR T cells with that of pembrolizumab plus CAR T cells (that lacked the switch receptor) in mice bearing human prostate tumor or mesothelioma, and found that the antitumor effect seen in mice treated with PD1CD28 CAR T cells was much stronger than in those treated with pembrolizumab with CAR T cells.
The researchers further demonstrated that the PD1CD28 CAR T cells had enhanced proliferative capacity and enhanced cell-killing ability compared with CAR T cells that lacked the switch receptor, and concluded that these factors may be responsible for superior regression of large solid tumors in mice.
“Some of the tumors we tested are very aggressive and resistant to other forms of therapy. We were surprised to see that the PD1CD28 CAR T cells led to a strong response and increased survival in many mice bearing such tumors as compared with CAR T cells without the switch receptor. We were also surprised to see that other forms of genetically engineered PD-1–based receptors did not have any enhancing effects on the CAR T cells. In fact, in some experiments, they did worse than the regular CAR T cells,” Dr. Moon said.
“We are hopeful that the great success seen with investigational CAR T-cell therapy in blood tumors will occur in solid tumors as well, as we continue to study ways to combine other immunotherapies with T-cell therapy, and better understand ways to augment T-cell function in solid tumors,” Dr. Moon concluded.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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