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PSMA 靶向 TGFβ 不敏感装甲 CAR T 细胞治疗转移性去势抵抗性前列腺癌:一项 1 期试验。

PSMA-targeting TGFβ-insensitive armored CAR T cells in metastatic castration-resistant prostate cancer: a phase 1 trial.

机构信息

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Nat Med. 2022 Apr;28(4):724-734. doi: 10.1038/s41591-022-01726-1. Epub 2022 Mar 21.


DOI:10.1038/s41591-022-01726-1
PMID:35314843
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10308799/
Abstract

Chimeric antigen receptor (CAR) T cells have demonstrated promising efficacy, particularly in hematologic malignancies. One challenge regarding CAR T cells in solid tumors is the immunosuppressive tumor microenvironment (TME), characterized by high levels of multiple inhibitory factors, including transforming growth factor (TGF)-β. We report results from an in-human phase 1 trial of castration-resistant, prostate cancer-directed CAR T cells armored with a dominant-negative TGF-β receptor (NCT03089203). Primary endpoints were safety and feasibility, while secondary objectives included assessment of CAR T cell distribution, bioactivity and disease response. All prespecified endpoints were met. Eighteen patients enrolled, and 13 subjects received therapy across four dose levels. Five of the 13 patients developed grade ≥2 cytokine release syndrome (CRS), including one patient who experienced a marked clonal CAR T cell expansion, >98% reduction in prostate-specific antigen (PSA) and death following grade 4 CRS with concurrent sepsis. Acute increases in inflammatory cytokines correlated with manageable high-grade CRS events. Three additional patients achieved a PSA reduction of ≥30%, with CAR T cell failure accompanied by upregulation of multiple TME-localized inhibitory molecules following adoptive cell transfer. CAR T cell kinetics revealed expansion in blood and tumor trafficking. Thus, clinical application of TGF-β-resistant CAR T cells is feasible and generally safe. Future studies should use superior multipronged approaches against the TME to improve outcomes.

摘要

嵌合抗原受体 (CAR) T 细胞已显示出良好的疗效,尤其在血液恶性肿瘤中。CAR T 细胞在实体瘤中面临的一个挑战是免疫抑制性肿瘤微环境 (TME),其特征是存在高水平的多种抑制因子,包括转化生长因子 (TGF)-β。我们报告了一项针对去势抵抗性前列腺癌的 CAR T 细胞的 1 期人体临床试验结果,该 CAR T 细胞被武装了一种显性负 TGF-β受体 (NCT03089203)。主要终点是安全性和可行性,次要目标包括评估 CAR T 细胞的分布、生物活性和疾病反应。所有预设的终点都达到了。18 名患者入组,其中 13 名患者在 4 个剂量水平接受了治疗。13 名患者中有 5 名发生了 ≥2 级细胞因子释放综合征 (CRS),其中 1 名患者发生了明显的克隆性 CAR T 细胞扩增,前列腺特异性抗原 (PSA) 下降超过 98%,并在伴有败血症的 4 级 CRS 后死亡。炎症细胞因子的急性增加与可管理的高级别 CRS 事件相关。另外 3 名患者 PSA 降低 ≥30%,在过继细胞转移后,CAR T 细胞衰竭伴随着多个 TME 定位抑制分子的上调。CAR T 细胞动力学显示在血液和肿瘤中的扩展。因此,TGF-β 抗性 CAR T 细胞的临床应用是可行的,通常是安全的。未来的研究应该使用针对 TME 的优越的多管齐下的方法来改善结果。

相似文献

[1]
PSMA-targeting TGFβ-insensitive armored CAR T cells in metastatic castration-resistant prostate cancer: a phase 1 trial.

Nat Med. 2022-4

[2]
Efficacy Against Human Prostate Cancer by Prostate-specific Membrane Antigen-specific, Transforming Growth Factor-β Insensitive Genetically Targeted CD8 T-cells Derived from Patients with Metastatic Castrate-resistant Disease.

Eur Urol. 2017-12-21

[3]
PSCA-CAR T cell therapy in metastatic castration-resistant prostate cancer: a phase 1 trial.

Nat Med. 2024-6

[4]
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Front Immunol. 2020

[5]
SMAD7 expression in CAR-T cells improves persistence and safety for solid tumors.

Cell Mol Immunol. 2024-3

[6]
[Current Trend of CAR-T Cell Therapy for Metastatic Castration-Resistant Prostate Cancer].

Gan To Kagaku Ryoho. 2023-10

[7]
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J Clin Invest. 2023-11-15

[8]
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Mol Ther. 2024-10-2

[9]
Dominant-Negative TGF-β Receptor Enhances PSMA-Targeted Human CAR T Cell Proliferation And Augments Prostate Cancer Eradication.

Mol Ther. 2018-5-8

[10]
Armored TGFβRIIDN ROR1-CAR T cells reject solid tumors and resist suppression by constitutively-expressed and treatment-induced TGFβ1.

J Immunother Cancer. 2024-4-12

引用本文的文献

[1]
PSMA-Directed Theranostics in Prostate Cancer.

Biomedicines. 2025-7-28

[2]
Challenges in the preclinical design and assessment of CAR-T cells.

Front Immunol. 2025-8-8

[3]
Constructing the cure: engineering the next wave of antibody and cellular immune therapies.

J Immunother Cancer. 2025-8-25

[4]
SCAN-ACT: adoptive T cell therapy target discovery through single-cell transcriptomics.

Genome Med. 2025-8-14

[5]
Co-expression of a truncated TGFβ receptor II in c-Met CAR T cells enhances antitumor activity against lung adenocarcinoma.

Sci Rep. 2025-8-11

[6]
Immunological synapse: structures, molecular mechanisms and therapeutic implications in disease.

Signal Transduct Target Ther. 2025-8-11

[7]
Advancing CAR-based cell therapies for solid tumours: challenges, therapeutic strategies, and perspectives.

Mol Cancer. 2025-7-7

[8]
Immunotherapy in metastatic prostate cancer.

Ther Adv Med Oncol. 2025-7-3

[9]
CAR-T cell therapy for cancer: current challenges and future directions.

Signal Transduct Target Ther. 2025-7-4

[10]
Prostate cancer immunotherapy-based strategies: an updated review emphasizing immune checkpoint inhibitors.

Front Immunol. 2025-6-18

本文引用的文献

[1]
NPM-ALK-Induced Reprogramming of Mature TCR-Stimulated T Cells Results in Dedifferentiation and Malignant Transformation.

Cancer Res. 2021-6-15

[2]
High systemic and tumor-associated IL-8 correlates with reduced clinical benefit of PD-L1 blockade.

Nat Med. 2020-5-11

[3]
Elevated serum interleukin-8 is associated with enhanced intratumor neutrophils and reduced clinical benefit of immune-checkpoint inhibitors.

Nat Med. 2020-5-11

[4]
Multiplex digital spatial profiling of proteins and RNA in fixed tissue.

Nat Biotechnol. 2020-5-11

[5]
Locoregionally administered B7-H3-targeted CAR T cells for treatment of atypical teratoid/rhabdoid tumors.

Nat Med. 2020-4-27

[6]
Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings.

Cancer Imaging. 2020-3-14

[7]
CD19-targeting CAR T cell immunotherapy outcomes correlate with genomic modification by vector integration.

J Clin Invest. 2020-2-3

[8]
Long-term in vivo microscopy of CAR T cell dynamics during eradication of CNS lymphoma in mice.

Proc Natl Acad Sci U S A. 2019-11-11

[9]
Clonal expansion of CAR T cells harboring lentivector integration in the CBL gene following anti-CD22 CAR T-cell therapy.

Blood Adv. 2019-8-13

[10]
GLCCI1 is a novel protector against glucocorticoid-induced apoptosis in T cells.

FASEB J. 2019-3-12

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