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:Autologous Glypican-3-Targeted, Armored CAR T Cells in Patients with Advanced Solid Tumors: A Phase 1 Dose-Escalation Study of TAK-102.
这些发现支持TAK-102具有可控的安全性特征,并为其在实体瘤中的生物学活性提供了早期证据。
嵌合抗原受体(CAR)T细胞疗法由于免疫抑制性肿瘤微环境,在实体瘤中的前景有限。TAK-102是一种下一代靶向磷脂酰肌醇蛋白聚糖-3(GPC3)的CAR T细胞疗法,经工程化改造以共表达白细胞介素-7(IL-7)和趋化因子配体19(CCL19),从而增强T细胞存活和迁移。在这项首次人体、开放标签、1期、剂量递增研究(ClinicalTrials.gov:NCT04405778)中,我们评估了单次输注TAK-102在11例对标准治疗难治或不耐受的GPC3+晚期实体瘤患者中的效果。患者在白细胞分离术和淋巴细胞清除化疗后接受三个剂量水平之一的TAK-102。主要终点为剂量限制性毒性、治疗中出现的不良事件和特别关注的不良事件的发生率。未观察到剂量限制性毒性。最常见的治疗中出现的不良事件为血液学事件,包括中性粒细胞减少和白细胞减少(81.8%),以及细胞因子释放综合征(54.5%),均为1-2级。未观察到客观缓解;然而,5例患者达到疾病稳定(疾病控制率,45.5%)。1例患者肿瘤缩小26.1%,持续9个月,同时血清甲胎蛋白下降51.6%。细胞动力学显示剂量依赖性扩增,最高暴露量为5 10 CAR+细胞/体重。治疗后活检显示CD8+ T细胞浸润和活化标志物增加,尽管在肿瘤组织中未检测到CAR+细胞。血清CCL19水平随剂量增加,提示免疫启动。这些发现支持TAK-102具有可控的安全性特征,并提供了其在实体瘤中生物学活性的早期证据。需要进一步开展研究以优化给药方案、改善 CAR T 细胞持久性,并在更大的患者队列中评估疗效。
Chimeric antigen receptor (CAR) T-cell therapies have shown limited promise in solid tumors owing to the immunosuppressive tumor microenvironment. TAK-102 is a next-generation, glypican-3 (GPC3)-targeted CAR T-cell therapy engineered to co-express interleukin-7 (IL-7) and chemokine ligand 19 (CCL19), enhancing T-cell survival and trafficking. In this first-in-human, open-label, phase 1, dose-escalation study (ClinicalTrials.gov: NCT04405778), we evaluated a single TAK-102 infusion in 11 patients with GPC3+ advanced solid tumors refractory or intolerant to standard therapies. Patients received TAK-102 at one of three dose levels following leukapheresis and lymphodepletion chemotherapy. The primary endpoints were the incidences of dose-limiting toxicities, treatment-emergent adverse events, and adverse events of special interest. No dose-limiting toxicities were observed. The most common treatment-emergent adverse events were hematologic, including neutropenia and leukopenia (81.8%), and cytokine release syndrome (54.5%), all grade 1-2. No objective responses were observed; however, five patients achieved stable disease (disease control rate, 45.5%). One patient had a 26.1% reduction in tumor size lasting 9 months, accompanied by a 51.6% decline in serum alpha-fetoprotein. Cellular kinetics showed dose-dependent expansion, with the highest exposure at 5 10 CAR+ cells/body. Post-treatment biopsies revealed increased CD8+ T-cell infiltration and activation markers, although CAR+ cells were undetectable in tumor tissue. Serum CCL19 levels increased with dose, suggesting immune priming. These findings support a manageable safety profile for TAK-102 and provide early evidence of biological activity in solid tumors. Further studies are warranted to optimize dosing, improve CAR T-cell persistence, and evaluate efficacy in larger patient cohorts.
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