Gargett Tessa, Fraser Cara K, Dotti Gianpietro, Yvon Eric S, Brown Michael P
*Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology, and University of South Australia §Cancer Clinical Trials Unit, Royal Adelaide Hospital ∥Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia †Center for Cell and Gene Therapy, Baylor College of Medicine, The Methodist Hospital and Texas Children's Hospital ‡Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Immunother. 2015 Jan;38(1):12-23. doi: 10.1097/CJI.0000000000000061.
Cancer immunotherapy has long been used in the treatment of metastatic melanoma, and an anti-CTLA-4 monoclonal antibody treatment has recently been approved by the US Food and Drug Administration. Targeted therapies such as small molecule kinase inhibitors targeting deregulated mitogen-activated protein kinase (MAPK) signaling have markedly improved melanoma control in up to 50% of metastatic disease patients and have likewise been recently approved. Combination therapies for melanoma have been proposed as a way to exploit the high-level but short-term responses associated with kinase inhibitor therapies and the low-level but longer-term responses associated with immunotherapy. Cancer immunotherapy now includes adoptive transfer of autologous tumor-specific chimeric antigen receptor (CAR) T cells and this mode of therapy is a candidate for combination with small molecule drugs. This paper describes CART cells that target GD2-expressing melanoma cells and investigates the effects of approved MAPK pathway-targeted therapies for melanoma [vemurafenib (Vem), dabrafenib (Dab), and trametinib (Tram)] on the viability, activation, proliferation, and cytotoxic T lymphocyte activity of these CAR T cells, as well as on normal peripheral blood mononuclear cells. We report that, although all these drugs lead to inhibition of stimulated T cells at high concentrations in vitro, only Vem inhibited T cells at concentrations equivalent to reported plasma concentrations in treated patients. Although the combination of Dab and Tram also resulted in inhibition of T-cell effector functions at some therapeutic concentrations, Dab itself had little adverse effect on CAR T-cell function. These findings may have implications for novel therapeutic combinations of adoptive CAR T-cell immunotherapy and MAPK pathway inhibitors.
癌症免疫疗法长期以来一直用于转移性黑色素瘤的治疗,一种抗CTLA-4单克隆抗体疗法最近已获美国食品药品监督管理局批准。诸如靶向失调的丝裂原活化蛋白激酶(MAPK)信号传导的小分子激酶抑制剂等靶向疗法,已使高达50%的转移性疾病患者的黑色素瘤得到显著控制,且最近也已获批。黑色素瘤的联合疗法已被提出,作为一种利用与激酶抑制剂疗法相关的高水平但短期反应以及与免疫疗法相关的低水平但长期反应的方法。癌症免疫疗法现在包括自体肿瘤特异性嵌合抗原受体(CAR)T细胞的过继性转移,这种治疗方式是与小分子药物联合使用的候选方法。本文描述了靶向表达GD2的黑色素瘤细胞的CAR T细胞,并研究了已获批的针对黑色素瘤的MAPK途径靶向疗法[维莫非尼(Vem)、达拉非尼(Dab)和曲美替尼(Tram)]对这些CAR T细胞以及正常外周血单个核细胞的活力、活化、增殖和细胞毒性T淋巴细胞活性的影响。我们报告称,尽管所有这些药物在体外高浓度时都会导致对刺激T细胞的抑制,但只有维莫非尼在相当于治疗患者报告血浆浓度的浓度下抑制T细胞。尽管达拉非尼和曲美替尼的联合在某些治疗浓度下也会导致T细胞效应功能的抑制,但达拉非尼本身对CAR T细胞功能几乎没有不良影响。这些发现可能对过继性CAR T细胞免疫疗法和MAPK途径抑制剂的新型治疗组合具有启示意义。