决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Allogeneic B7-H3-Targeted CAR Vδ1T-cell Therapy in Advanced Solid Tumors: A Phase I Study.
本研究为异体B7-H3靶向CAR-Vδ1T细胞作为低GVHD风险的安全平台提供了临床概念验证,并证实其在实体瘤中具有可检测的生物学活性。然而,临床疗效受限于宿主免疫排斥导致的细胞持久性不足。未来需要采取策略以增强该异体方法的持久性和治疗潜力。
本研究旨在评估UTAA06——一种“即用型”同种异体B7-H3靶向嵌合抗原受体(CAR)V 1T细胞疗法——在经治的晚期B7-H3阳性实体瘤患者中的安全性、药代动力学及初步临床活性。
在这项首次人体、I期、剂量递增研究(NCT06372236)中,入组了10例晚期实体瘤患者(包括胃癌、结直肠癌、肝细胞癌、卵巢癌和神经内分泌癌)。在淋巴细胞清除性化疗(环磷酰胺和氟达拉滨)后,患者接受了三个剂量水平(5×10^8、8×10^8或1×10^9个细胞)的UTAA06输注。主要终点为安全性。次要终点包括药代动力学和抗肿瘤疗效。
UTAA06 显示出可控的安全性特征;未观察到 GVHD,细胞因子释放综合征仅限于 2 例短暂的 1 级事件。在 5 108 细胞剂量水平,1 例患者报告了单次剂量限制性毒性(3 级肺炎)。尽管 UTAA06 显示出生物学活性信号,包括 50% 患者血清肿瘤标志物短暂下降,但未观察到符合 RECIST v1.1 标准的客观缓解。进一步分析发现,CAR T 细胞持久性有限可能由亚临床宿主抗移植物排斥驱动。
PURPOSE: The aim of the study was to evaluate the safety, pharmacokinetics, and preliminary clinical activity of UTAA06, an "off-the-shelf" allogeneic B7-H3-targeted chimeric antigen receptor (CAR) V 1T-cell therapy, in patients with pretreated, advanced B7-H3-positive solid tumors. PATIENTS AND METHODS: In this first-in-human, phase I, dose-escalation study (NCT06372236), 10 patients with advanced solid tumors (including gastric, colorectal, hepatocellular, ovarian, and neuroendocrine cancers) were enrolled. Following lymphodepletion chemotherapy (cyclophosphamide and fludarabine), patients received UTAA06 infusion across three dose levels (5 108, 8 108, or 1 109 cells). The primary endpoint was safety. Secondary endpoints included pharmacokinetics and antitumor efficacy. RESULTS: UTAA06 demonstrated a manageable safety profile; no GVHD was observed, and cytokine release syndrome was limited to two transient grade 1 events. A single dose-limiting toxicity (grade 3 pneumonitis) was reported in one patient at the 5 108 cell dose level. Although UTAA06 demonstrated signals of biological activity, including transient reductions in serum tumor markers in 50% of patients, no objective response by RECIST v1.1 criteria was observed. Further analysis identified that the limited CAR T-cell persistence was likely driven by subclinical host-versus-graft rejection. CONCLUSIONS: This study provides clinical proof of concept for allogeneic B7-H3-targeted CAR-V 1T cells as a safe platform with low risk of GVHD and demonstrable biological activity in solid tumors. However, clinical efficacy was constrained by limited cellular persistence caused by host immune rejection. Future strategies are required to enhance the durability and therapeutic potential of this allogeneic approach.
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