Q1 · MEDICINE
Article
Author: Aguilar, Brenda ; Zhou, Yuanyue ; Brown, Christine E ; Wang, Shelley ; Holmes, Michael C ; Wagner, Jamie R ; Mendel, Matthew ; Ressler, Julie A ; Palmer, Joycelynne ; Gregory, Philip D ; Weng, Lihong ; Reik, Andreas ; Starr, Renate ; Badie, Behnam ; Ostberg, Julie R ; Jensen, Michael C ; Forman, Stephen J ; Naranjo, Araceli ; D’Apuzzo, Massimo ; Tang, Winson W ; Rodriguez, Analiz ; Tran, Vivi ; Synold, Timothy W
Background:Wide-spread application of chimeric antigen receptor (CAR) T cell therapy for cancer is limited by the current use of autologous CAR T cells necessitating the manufacture of individualized therapeutic products for each patient. To address this challenge, we have generated an off-the-shelf, allogeneic CAR T cell product for the treatment of glioblastoma (GBM), and present here the feasibility, safety, and therapeutic potential of this approach.
Methods:We generated for clinical use a healthy-donor derived IL13Rα2-targeted CAR+ (IL13-zetakine+) cytolytic T-lymphocyte (CTL) product genetically engineered using zinc finger nucleases (ZFNs) to permanently disrupt the glucocorticoid receptor (GR) (GRm13Z40-2) and endow resistance to glucocorticoid treatment. In a phase I safety and feasibility trial we evaluated these allogeneic GRm13Z40-2 T cells in combination with intracranial administration of recombinant human IL-2 (rhIL-2; aldesleukin) in six patients with unresectable recurrent GBM that were maintained on systemic dexamethasone (4-12 mg/day).
Results:The GRm13Z40-2 product displayed dexamethasone-resistant effector activity without evidence for in vitro alloreactivity. Intracranial administration of GRm13Z40-2 in four doses of 108 cells over a two-week period with aldesleukin (9 infusions ranging from 2500–5000 IU) was well tolerated, with indications of transient tumor reduction and/or tumor necrosis at the site of T cell infusion in four of the six treated research subjects. Antibody reactivity against GRm13Z40-2 cells was detected in the serum of only one of the four tested subjects.
Conclusions:This first-in-human experience establishes a foundation for future adoptive therapy studies using off-the-shelf, zinc-finger modified, and/or glucocorticoid resistant CAR T cells.