Article
Author: Hinchey, Conor ; Leonetti, Alessandro ; Campanini, Nicoletta ; Tsai, Jeanelle A. ; Gnetti, Letizia ; Tolstorukov, Michael Yevgeniy ; Mansuet-Lupo, Audrey ; Tuladhar, Bishma ; Smith, Eric L. ; Gokhale, Prafulla C. ; Lizotte, Patrick Hall ; Jänne, Pasi A. ; Haller, William ; Paweletz, Cloud P. ; Ngo, Kenneth ; Hartley, Antja-Voy ; Feng, William W. ; Locquet, Marie-Anaïs ; Baldacci, Simon ; Chakravarti, Sachiv ; Facchinetti, Francesco ; Fournel, Ludovic ; Booker, Matthew A. ; Bui, Karen ; D’Agnelli, Simona ; Mahadevan, Navin R. ; Alifano, Marco ; Zielinska, Magdalena ; Sequist, Lecia V. ; Zasadil, Lauren M. ; Saldanha, Aisha ; Li, Zhaorong ; Ivanova, Elena V. ; Lococo, Filippo ; Barbie, David A. ; Malhotra, Soumya ; Brea, Elliott J.
Abstract:EGFR tyrosine kinase inhibitors have dramatically improved outcomes for patients with EGFR-mutated non–small cell lung cancer (NSCLC), but relapse frequently occurs because of drug-tolerant persister (DTP) cells that can evolve and develop diverse mechanisms of drug resistance. In samples from patients with EGFR-mutated NSCLC treated with EGFR tyrosine kinase inhibitors in the neoadjuvant setting, we observed enriched expression of the cell surface protein TROP2, a target of clinically active antibody–drug conjugates (ADC). We confirmed these findings across multiple EGFR-mutated NSCLC cell line and patient-derived xenograft models treated with osimertinib in vivo. Treatment with the TROP2 ADC sacituzumab govitecan at the time of osimertinib-induced minimal residual disease only modestly delayed tumor recurrence in vivo, whereas a single infusion of sacituzumab-based TROP2-directed chimeric antigen receptor (CAR) T cells significantly prolonged relapse-free survival, with evidence of cure. These data highlight the potential of engineering TROP2 CAR T-cell therapy to eliminate EGFR DTPs in patients.
Significance::We provide a rationale for targeting TROP2 in EGFR-mutated NSCLC DTPs. In contrast to TROP2 ADC therapy, targeting of TROP2 with CAR-T cells can eliminate osimertinib-induced DTPs in vivo, revealing the promise of developing novel TROP2-based CAR-T cells to promote durable response and prevent disease relapse in patients.