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:Phase I Trial of GPC3-Targeted TCR Fusion Construct, CT0180, in patients with Advanced Hepatocellular Carcinoma.
CT0180在经多线治疗的HCC中显示出初步可控的安全性特征和临床活性,支持进一步开展临床评价。
晚期肝细胞癌(HCC)的治疗选择仍然有限,后线治疗的缓解率也不理想。Glypican-3(GPC3)在HCC中高表达而在正常组织中罕见表达,是一个有吸引力的肿瘤特异性靶点。CT0180是一种靶向GPC3的单链可变区片段,与CD3连接,旨在整合入天然T细胞受体(TCR)复合物,并在结合GPC3后激活完整的TCR信号传导。
在这项开放标签、剂量递增的I期试验中,对标准治疗进展或不耐受的晚期GPC3阳性HCC患者,在氟达拉滨/环磷酰胺淋巴细胞清除后接受CT0180治疗。研究目标为安全性、初步疗效和细胞药代动力学。采用单细胞RNA测序(scRNA-seq)和TCR测序分析免疫重建。
7例患者接受了4个剂量水平(DL)的15次输注:1×10(n=1)、3×10(n=1)、1×10(n=3)和3×10(n=2)细胞。3-4级不良事件主要为血液学毒性。细胞因子释放综合征发生于85.7%的患者,均为1级,未观察到剂量限制性毒性或免疫效应细胞相关神经毒性。2例患者(DL2和DL4)达到部分缓解,3例(DL1、DL3和DL4)达到疾病稳定,客观缓解率为28.6%,疾病控制率为71.4%。中位无进展生存期和总生存期分别为7.6个月和11.6个月。scRNA-seq显示,临床获益患者基线时NK细胞富集,重复输注后细胞毒性CD8效应细胞持续扩增。
PURPOSE: Treatment options for advanced hepatocellular carcinoma (HCC) remain limited, and responses to later-line therapies are modest. Glypican-3 (GPC3), highly expressed in HCC but rarely in normal tissues, is an attractive tumor-specific target. CT0180 is a GPC3-targeted single-chain fragment variable linked to CD3 designed to integrate into the native T cell receptor (TCR) complex and activate full TCR signaling upon GPC3 binding. METHODS: In this open-label, dose-escalation phase I trial, patients with advanced GPC3-positive HCC that had progressed on or were intolerant to standard therapies received CT0180 after fludarabine/cyclophosphamide lymphodepletion. The study objectives were safety, preliminary efficacy, and cellular pharmacokinetics. Single-cell RNA sequencing (scRNA-seq) and TCR sequencing were used to profile immune reconstitution. RESULTS: Seven patients received 15 infusions across four dose levels (DLs): 1 10 (n=1), 3 10 (n=1), 1 10 (n=3), and 3 10 (n=2) cells. Grade 3-4 adverse events were primarily hematologic. Cytokine release syndrome occurred in 85.7% of patients, all grade 1 with no dose-limiting toxicities or immune effector cell-associated neurotoxicity observed. Two patients (at DL2 and DL4) achieved partial responses, and three (at DL1, DL3, and DL4) achieved stable disease, yielding an objective response rate of 28.6% and a disease control rate of 71.4%. Median progression-free and overall survival were 7.6 and 11.6 months, respectively. scRNA-seq revealed baseline NK-cell enrichment in patients with clinical benefit and sustained cytotoxic CD8 effector expansion after repeat infusion. CONCLUSIONS: CT0180 demonstrated a preliminary manageable safety profile and clinical activity in heavily pretreated HCC, supporting further clinical evaluation.
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