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:Clinical results of an HBV-specific T-cell receptor-T-cell therapy (SCG101) in patients with HBV-related hepatocellular carcinoma treated in an investigator-initiated, interventional trial.
作为 HBV-HCC 患者的单药治疗,SCG101 显示出显著的抗病毒和抗肿瘤活性,安全性特征可通过支持治疗进行管理。
背景:SCG101 是一种自体 T 细胞疗法,利用稳定表达的天然高亲和力 T 细胞受体特异性靶向乙型肝炎病毒(HBV)。目的:在研究者发起的试验中,评估 SCG101 治疗 HBV 相关肝细胞癌(HCC)患者的安全性、药代动力学、药效学和疗效。设计:6 例 HLA-A*02:01 阳性、血清乙肝表面抗原(HBsAg)阳性、乙肝 e 抗原阴性的晚期 HBV-HCC 患者,既往接受 1–3 种全身治疗失败,在淋巴清除后 3 天接受 SCG101,剂量为 5 × 10⁷ 或 1 × 10⁸ 个 TCR-T⁺ 细胞/kg。结果:1 周内所有患者均出现显著但短暂的丙氨酸氨基转移酶升高,并伴随外周血 T 细胞扩增 76 ± 57 倍。未观察到神经毒性,但出现最高达 3 级的 CRS。这些不良反应未达到剂量限制性毒性,可通过皮质类固醇、抗 IL-6 治疗和/或升压药管理。提示 SCG101 具有靶向活性,患者血清 HBsAg 在 2 周内下降 1.96 log₁₀(0.16–3.84)。按修订版实体瘤疗效评价标准,6 例中 3 例靶病灶缩小,最佳变化分别为 −19.5%、−74.6% 和 −100%。1 例靶病灶完全缓解且无进展生存达 27 个月,另 1 例获得持久(>6 个月)缓解。中位随访 10.9 个月期间,3 例死亡,1 例失访。结论:SCG101 单药治疗 HBV-HCC 显示出显著抗病毒和抗肿瘤活性,其安全性可通过支持治疗管理。T 细胞扩增、血清 HBsAg 下降及肿瘤应答共同支持其靶向活性。试验注册号:NCT05339321。
BACKGROUND: SCG101 is an autologous T-cell therapy specifically targeting hepatitis B virus (HBV) using a natural, high-affinity T-cell receptor that is stably expressed. OBJECTIVE: We evaluated the safety, pharmacokinetics, pharmacodynamics and efficacy of SCG101 in patients with HBV-related hepatocellular carcinoma (HCC) in an investigator-initiated trial. DESIGN: Six human leucocyte antigen (HLA)-A*02:01-positive, serum hepatitis B surface antigen (HBsAg)-positive and hepatitis B e antigen-negative patients with advanced HBV-HCC, who had failed one to three prior systemic therapies, received SCG101 at doses of 5 10 7 or 1 10 8 TCR-T + cells/kg three days after lymphodepletion. RESULTS: Within 1 week, all patients experienced a significant but transient alanine aminotransferase elevation paralleled by a 76 57 fold expansion of T cells detected in peripheral blood. No neurotoxicity, but a cytokine release syndrome reaching up to grade 3 was observed. However, these side effects were not dose-limiting and could be managed with corticosteroids, anti-interleukin-6 and/or vasopressor therapy. Indicating on-target activity of SCG101, serum HBsAg levels dropped by 1.96 (0.16-3.84) log 10 within 2 weeks. According to modified Response Evaluation Criteria in Solid Tumours, three of the six patients achieved tumour shrinkage with a best percentage change in target lesion size of -19.5%, -74.6% and -100%. One showed complete remission of the target lesion, remaining progression-free for 27 months and one other achieved a durable (>6 months) remission. During follow-up (median 10.9 months), three patients died, and one was lost to follow-up. CONCLUSION: As monotherapy for patients with HBV-HCC, SCG101 demonstrated pronounced antiviral and antitumour activities and a safety profile manageable with supportive care. SCG101's T-cell expansion, serum HBsAg drop and tumour response collectively underscore on-target activity. TRIAL REGISTRATION NUMBER: NCT05339321.
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