← 返回前沿论文

自体细胞基因治疗中有意为之的异质性:首次人体试验的策略考量

英文原题:Intentional heterogeneity in autologous cell-based gene therapies: strategic considerations for first-in-human trials.

PubMed 2025/06/05(内容时间) J Immunother Cancer Q1 · IF 11.7(JCR 2025)

研究概要

基于细胞的基因疗法,包括CAR-T、TCR-T和TIL疗法,已经改变了某些癌症的治疗格局,但其在实体瘤中的疗效仍然有限。

中文摘要

基于细胞的基因疗法,包括嵌合抗原受体-T、T细胞受体-T和TIL(肿瘤浸润淋巴细胞)疗法,已改变了某些癌症的治疗格局,但其在实体瘤中的疗效仍然有限。下一代疗法旨在通过创新方法克服生物学屏障、增强效力和安全性,并简化开发时间线。基因组编辑技术的最新进展已在临床前模型中鉴定出数百种可改善T细胞功能的基因编辑。然而,这些发现有限的直接可转化性,以及在传统临床试验中逐一测试每种单个编辑的不切实际性,凸显了对更高效策略的需求。本文概述了全基因组筛选,这些筛选可鉴定增强T细胞功能的基因敲除和敲入,并讨论了将这些结果转化至人体试验的局限性。接下来,我们提出一种新颖的临床试验设计,用于在单一T细胞输注产品中同时测试多种基因修饰。这种方法将能够在内部对照环境中对编辑进行头对头评估,加速鉴定有前景的候选编辑。本文讨论了化学、制造和控制、非临床评价以及临床方案的关键考虑因素,并强调患者安全和伦理透明度。该框架参考了2024年5月6日举行的“Unlocking Complex Cell-based Gene Therapies”研讨会上分享的见解。该活动由Friends of Cancer Research和Parker Institute for Cancer Immunotherapy共同主办,汇集了来自学术界、美国食品药品监督管理局和患者倡导组织的参与者。通过促进这些利益相关方之间的合作,这一创新方法旨在加速针对复杂疾病的有效基于细胞的疗法的开发。

展开英文摘要原文

Cell-based gene therapies, including chimeric antigen receptor-T, T-cell receptor-T, and tumor-infiltrating lymphocyte therapies, have transformed the treatment landscape for certain cancers, yet their efficacy in solid tumors remains limited. Next-generation therapies aim to overcome biological barriers, enhance potency and safety, and streamline development timelines through innovative approaches. Recent advances in genome editing technologies have identified hundreds of gene edits that improve T-cell functionality in preclinical models. However, the limited direct translatability of these findings and the impracticality of testing each of the individual edits in a traditional clinical trial highlight the need for more efficient strategies.This article provides an overview of genome-wide screens that identify gene knockouts and knock-ins to enhance T-cell function and the limitations with translating these results to human trials. Next, we propose a novel clinical trial design for testing multiple gene modifications simultaneously within a single T-cell infusion product. This approach would enable head-to-head evaluation of edits in an internally controlled setting, accelerating the identification of promising candidate edits. Key considerations for Chemistry, Manufacturing, and Controls, non-clinical evaluation, and clinical protocols are discussed, with an emphasis on patient safety and ethical transparency.This framework is informed by insights shared at the "Unlocking Complex Cell-based Gene Therapies" workshop, held on May 6, 2024. Co-hosted by Friends of Cancer Research and the Parker Institute for Cancer Immunotherapy, the event brought together participants from academia, the US Food and Drug Administration, and patient advocacy groups. By fostering collaboration among these stakeholders, this innovative approach aims to accelerate the development of effective cell-based therapies for complex diseases.

论文信息

作者
Cabanski CR、Yang E、Stewart MD、Allen JD、Connolly JE、Dugan U、Greenberg PD、Mackall CL
第一作者单位
Parker Institute for Cancer Immunotherapy, San Francisco, California, USA.United States
通讯作者单位
Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, California, USA aribas@mednet.ucla.edu mvmaus@mgh.harvard.edu.United States
文献类型
综述
期刊
Journal for immunotherapy of cancer2025 Jun 5
原文标识
PubMed 40480658 · DOI 10.1136/jitc-2024-011301