为肝细胞癌武装 GPC3 CAR T 细胞:多少才足够,下一步是什么?
Armouring GPC3 CAR T cells for hepatocellular carcinoma: how much is enough and what comes next?
英文原题:Genetically-modified, redirected T cells target hepatitis B surface antigen-positive hepatocytes and hepatocellular carcinoma lesions in a clinical setting.
SCG101 T细胞疗法在临床前模型以及一例原发性HBV-HCC合并慢性乙型肝炎患者中显示出令人鼓舞的疗效和安全性,具有清除HBsAg+细胞并在单次给药后实现持续肿瘤控制的能力。
乙型肝炎病毒(HBV)-DNA整合在HBV相关肝细胞癌(HBV-HCC)中可被HBV特异性T细胞靶向。SCG101是一种自体HBV特异性T细胞产品,经慢病毒转导后表达T细胞受体(TCR),识别HLA-A2上的包膜衍生肽(S20-28)。我们在此对其安全性和有效性进行了临床前验证,并将其应用于一名HBV相关HCC患者(NCT05339321)。
按照良好生产规范制造的细胞针对肝癌细胞进行了脱靶反应性和功能评估。随后,一名晚期HBV-HCC患者(Child-Pugh A级,巴塞罗那临床肝癌B期,东部肿瘤协作组体能状态0,乙型肝炎e抗原阴性,血清乙型肝炎表面抗原[HBsAg]阳性,HBsAg阳性肝细胞10%)在淋巴细胞清除后接受了7.9×107个细胞/kg。评估了安全性、T细胞持久性以及抗病毒和抗肿瘤疗效。
SCG101在封闭袋系统中高产制备,在体外和体内均显示出针对HBV-HCC细胞的HBV特异性功能。临床上,治疗耐受性良好,包括短暂性肝损伤在内的所有不良事件均可逆。第3天,ALT水平升高至1,404 U/L,同时血清HBsAg开始下降3.84 log10,并保持在<1 IU/mL超过六个月。73天后,肝活检中表达HBsAg的肝细胞检测不到。根据改良RECIST,患者达到部分缓解,靶病灶大小缩小>70%。转移的T细胞扩增,形成干细胞样记忆表型,并在患者血液中六个月后仍可检测到。
BACKGROUND/AIMS: Hepatitis B virus (HBV)-DNA integration in HBV-related hepatocellular carcinoma (HBV-HCC) can be targeted by HBV-specific T cells. SCG101 is an autologous, HBV-specific T-cell product expressing a T-cell receptor (TCR) after lentiviral transduction recognizing the envelope-derived peptide (S20-28) on HLA-A2. We here validated its safety and efficacy preclinically and applied it to an HBV-related HCC patient (NCT05339321). METHODS: Good Manufacturing Practice-grade manufactured cells were assessed for off-target reactivity and functionality against hepatoma cells. Subsequently, a patient with advanced HBV-HCC (Child-Pugh class A, Barcelona Clinic Liver Cancer stage B, Eastern Cooperative Oncology Group performance status 0, hepatitis B e antigen-, serum hepatitis B surface antigen [HBsAg]+, HBsAg+ hepatocytes 10%) received 7.9×107 cells/kg after lymphodepletion. Safety, T-cell persistence, and antiviral and antitumor efficacy were evaluated. RESULTS: SCG101, produced at high numbers in a closed-bag system, showed HBV-specific functionality against HBV-HCC cells in vitro and in vivo. Clinically, treatment was well tolerated, and all adverse events, including transient hepatic damage, were reversible. On day 3, ALT levels increased to 1,404 U/L, and concurrently, serum HBsAg started decreasing by 3.84 log10 and remained <1 IU/mL for over six months. HBsAg-expressing hepatocytes in liver biopsies were undetectable after 73 days. The patient achieved a partial response according to modified RECIST with a >70% reduction in target lesion size. Transferred T cells expanded, developed a stem cell-like memory phenotype, and were still detectable after six months in the patient's blood. CONCLUSION: SCG101 T-cell therapy showed encouraging efficacy and safety in preclinical models and in a patient with primary HBV-HCC and concomitant chronic hepatitis B with the capability to eliminate HBsAg+ cells and achieve sustained tumor control after single dosing.
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