Department of Molecular Biology and Immunology, Institute of Basic Medicine and.
Department of Bio-therapeutic, The First Medical Center, Chinese PLA General Hospital, Beijing, China; and.
Blood. 2020 Oct 1;136(14):1632-1644. doi: 10.1182/blood.2020005278.
Chimeric antigen receptor (CAR) T cells targeting CD19 have achieved breakthroughs in the treatment of hematological malignancies, such as relapsed/refractory non-Hodgkin lymphoma (r/rNHL); however, high rates of treatment failure and recurrence after CAR T-cell therapy are considerable obstacles to overcome. In this study, we designed a series of tandem CARs (TanCARs) and found that TanCAR7 T cells showed dual antigen targeting of CD19 and CD20, as well as formed superior and stable immunological synapse (IS) structures, which may be related to their robust antitumor activity. In an open-label single-arm phase 1/2a trial (NCT03097770), we enrolled 33 patients with r/rNHL; 28 patients received an infusion after conditioning chemotherapy. The primary objective was to evaluate the safety and tolerability of TanCAR7 T cells. Efficacy, progression-free survival, and overall survival were evaluated as secondary objectives. Cytokine release syndrome occurred in 14 patients (50%): 36% had grade 1 or 2 and 14% had grade 3. No cases of CAR T-cell-related encephalopathy syndrome (CRES) of grade 3 or higher were confirmed in any patient. One patient died from a treatment-associated severe pulmonary infection. The overall response rate was 79% (95% confidence interval [CI], 60-92%), and the complete response rate was 71%. The progression-free survival rate at 12 months was 64% (95% CI, 43-79%). In this study, TanCAR7 T cells elicited a potent and durable antitumor response, but not grade 3 or higher CRES, in patients with r/rNHL.
嵌合抗原受体(CAR)T 细胞靶向 CD19 在血液系统恶性肿瘤的治疗中取得了突破,例如复发/难治性非霍奇金淋巴瘤(r/rNHL);然而,CAR T 细胞治疗后治疗失败和复发的高比率仍然是需要克服的重大障碍。在这项研究中,我们设计了一系列串联 CAR(TanCAR),发现 TanCAR7 T 细胞对 CD19 和 CD20 具有双重抗原靶向作用,并且形成了优越和稳定的免疫突触(IS)结构,这可能与其强大的抗肿瘤活性有关。在一项开放标签的单臂 1/2a 期试验(NCT03097770)中,我们招募了 33 名 r/rNHL 患者;28 名患者在预处理化疗后接受输注。主要目的是评估 TanCAR7 T 细胞的安全性和耐受性。疗效、无进展生存期和总生存期作为次要目标进行评估。细胞因子释放综合征发生在 14 名患者(50%)中:36%为 1 级或 2 级,14%为 3 级。没有患者发生 3 级或以上的 CAR T 细胞相关脑病综合征(CRES)。1 名患者因治疗相关严重肺部感染而死亡。总缓解率为 79%(95%置信区间[CI],60-92%),完全缓解率为 71%。12 个月时无进展生存率为 64%(95%CI,43-79%)。在这项研究中,TanCAR7 T 细胞在 r/rNHL 患者中引发了强烈而持久的抗肿瘤反应,但没有 3 级或以上的 CRES。
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