Article
Author: Duh, Allison K. ; Monje, Michelle ; Petersen, Ann-Louise G. ; Song, Kun-Wei ; Campen, Cynthia J. ; Kamens, Jen ; Erickson, Courtney ; Pham, Kymhuynh ; Green, Sean ; Rietberg, Skyler P. ; Davis, Kara L. ; Richards, Rebecca M ; Yeom, Kristen W. ; Reschke, Agnes ; Feldman, Steven A ; Moon, Jennifer ; Yeom, Kristen W ; Siddiqui, Aman ; Feldman, Steven A. ; Davis, Kara L ; Campen, Cynthia J ; Fujimoto, Michelle ; Partap, Sonia ; Lim, Alexandria Sung ; Jacobs, Ashley ; Kunicki, Michael ; Reynolds, Warren D ; Fisher, Paul G ; Cornell, Timothy T ; Richards, Rebecca M. ; Reynolds, Warren D. ; Tunuguntla, Ramya ; Ramakrishna, Sneha ; Beebe, Barbara ; Cornell, Timothy T. ; McIntyre, Catherine ; Prabhu, Snehit ; Klysz, Dorota Danuta ; Musa, Eric ; Patel, Shabnum ; Petersen, Ann-Louise G ; Rasmussen, Lindsey ; Rietberg, Skyler P ; Kuo, Adam ; Villar, Katlin ; Grant, Gerald ; Fowler, Carley ; Majzner, Robbie ; Prolo, Laura ; Fisher, Paul G. ; Duh, Allison K ; Schultz, Liora M ; Chinnasamy, Harshini ; Sahaf, Bita ; Carr, Casey ; Ye, Xiaobu ; Schultz, Liora M. ; Egeler, Emily ; Barsan, Valentin ; Brown, Annie Kathleen ; Baggott, Christina ; Bove, Rachel ; Mackall, Crystal ; Mahdi, Jasia ; Mavroukakis, Sharon ; Lepori-Bui, Nadia
H3K27M-mutant diffuse midline gliomas (DMGs) express high levels of the disialoganglioside GD2 (ref. 1). Chimeric antigen receptor-modified T cells targeting GD2 (GD2-CART) eradicated DMGs in preclinical models1. Arm A of Phase I trial no. NCT04196413 (ref. 2) administered one intravenous (IV) dose of autologous GD2-CART to patients with H3K27M-mutant pontine (DIPG) or spinal DMG (sDMG) at two dose levels (DL1, 1 × 106 kg-1; DL2, 3 × 106 kg-1) following lymphodepleting chemotherapy. Patients with clinical or imaging benefit were eligible for subsequent intracerebroventricular (ICV) intracranial infusions (10-30 × 106 GD2-CART). Primary objectives were manufacturing feasibility, tolerability and the identification of maximally tolerated IV dose. Secondary objectives included preliminary assessments of benefit. Thirteen patients enroled, with 11 receiving IV GD2-CART on study (n = 3 DL1 (3 DIPG); n = 8 DL2 (6 DIPG, 2 sDMG)). GD2-CART manufacture was successful for all patients. No dose-limiting toxicities occurred on DL1, but three patients experienced dose-limiting cytokine release syndrome on DL2, establishing DL1 as the maximally tolerated IV dose. Nine patients received ICV infusions, with no dose-limiting toxicities. All patients exhibited tumour inflammation-associated neurotoxicity, safely managed with intensive monitoring and care. Four patients demonstrated major volumetric tumour reductions (52, 54, 91 and 100%), with a further three patients exhibiting smaller reductions. One patient exhibited a complete response ongoing for over 30 months since enrolment. Nine patients demonstrated neurological benefit, as measured by a protocol-directed clinical improvement score. Sequential IV, followed by ICV GD2-CART, induced tumour regressions and neurological improvements in patients with DIPG and those with sDMG.