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抗 EGFRvIII CAR T 细胞重复外周输注联合 pembrolizumab 治疗胶质母细胞瘤无效:一项 I 期试验。

Repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab show no efficacy in glioblastoma: a phase 1 trial.

机构信息

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

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

出版信息

Nat Cancer. 2024 Mar;5(3):517-531. doi: 10.1038/s43018-023-00709-6. Epub 2024 Jan 12.


DOI:10.1038/s43018-023-00709-6
PMID:38216766
Abstract

We previously showed that chimeric antigen receptor (CAR) T-cell therapy targeting epidermal growth factor receptor variant III (EGFRvIII) produces upregulation of programmed death-ligand 1 (PD-L1) in the tumor microenvironment (TME). Here we conducted a phase 1 trial (NCT03726515) of CAR T-EGFRvIII cells administered concomitantly with the anti-PD1 (aPD1) monoclonal antibody pembrolizumab in patients with newly diagnosed, EGFRvIII glioblastoma (GBM) (n = 7). The primary outcome was safety, and no dose-limiting toxicity was observed. Secondary outcomes included median progression-free survival (5.2 months; 90% confidence interval (CI), 2.9-6.0 months) and median overall survival (11.8 months; 90% CI, 9.2-14.2 months). In exploratory analyses, comparison of the TME in tumors harvested before versus after CAR + aPD1 administration demonstrated substantial evolution of the infiltrating myeloid and T cells, with more exhausted, regulatory, and interferon (IFN)-stimulated T cells at relapse. Our study suggests that the combination of CAR T cells and PD-1 inhibition in GBM is safe and biologically active but, given the lack of efficacy, also indicates a need to consider alternative strategies.

摘要

我们之前曾表明,针对表皮生长因子受体变异 III(EGFRvIII)的嵌合抗原受体(CAR)T 细胞疗法会导致肿瘤微环境(TME)中程序性死亡配体 1(PD-L1)的上调。在这里,我们进行了一项 1 期临床试验(NCT03726515),在新诊断的 EGFRvIII 胶质母细胞瘤(GBM)患者中同时给予 CAR T-EGFRvIII 细胞和抗 PD-1(aPD1)单克隆抗体 pembrolizumab(n=7)。主要终点是安全性,未观察到剂量限制毒性。次要终点包括中位无进展生存期(5.2 个月;90%置信区间[CI],2.9-6.0 个月)和中位总生存期(11.8 个月;90%CI,9.2-14.2 个月)。在探索性分析中,比较 CAR + aPD1 给药前后采集的肿瘤 TME 发现,浸润性髓样细胞和 T 细胞发生了实质性演变,在复发时具有更多耗竭、调节和干扰素(IFN)刺激的 T 细胞。我们的研究表明,在 GBM 中,CAR T 细胞与 PD-1 抑制的联合使用是安全且具有生物学活性的,但鉴于缺乏疗效,也表明需要考虑替代策略。

相似文献

[1]
Repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab show no efficacy in glioblastoma: a phase 1 trial.

Nat Cancer. 2024-3

[2]
A single dose of peripherally infused EGFRvIII-directed CAR T cells mediates antigen loss and induces adaptive resistance in patients with recurrent glioblastoma.

Sci Transl Med. 2017-7-19

[3]
Selective Targeting of Glioblastoma with EGFRvIII/EGFR Bitargeted Chimeric Antigen Receptor T Cell.

Cancer Immunol Res. 2018-9-10

[4]
Pilot Trial of Adoptive Transfer of Chimeric Antigen Receptor-transduced T Cells Targeting EGFRvIII in Patients With Glioblastoma.

J Immunother. 2019-5

[5]
PD1 Expression in EGFRvIII-Directed CAR T Cell Infusion Product for Glioblastoma Is Associated with Clinical Response.

Front Immunol. 2022

[6]
Chimeric Antigen Receptor T Cells in Glioblastoma-Current Concepts and Promising Future.

Cells. 2023-7-3

[7]
Antitumor efficacy of chimeric antigen receptor T cells against EGFRvIII-expressing glioblastoma in C57BL/6 mice.

Biomed Pharmacother. 2019-3-5

[8]
EGFRvIII-CAR-T Cells with PD-1 Knockout Have Improved Anti-Glioma Activity.

Pathol Oncol Res. 2020-10

[9]
EGFRvIII-specific chimeric antigen receptor T cells migrate to and kill tumor deposits infiltrating the brain parenchyma in an invasive xenograft model of glioblastoma.

PLoS One. 2014-4-10

[10]
Combined antitumor effects of anti-EGFR variant III CAR-T cell therapy and PD-1 checkpoint blockade on glioblastoma in mouse model.

Cell Immunol. 2020-6

引用本文的文献

[1]
Can We Use CAR-T Cells to Overcome Immunosuppression in Solid Tumours?

Biology (Basel). 2025-8-12

[2]
CAR T cell therapy for central nervous system solid tumors: current progress and future directions.

Front Immunol. 2025-8-15

[3]
Evolving therapeutic strategies in glioblastoma: traditional approaches and novel interventions.

3 Biotech. 2025-9

[4]
Glioblastoma: From Pathophysiology to Novel Therapeutic Approaches.

Biomedicines. 2025-8-12

[5]
Unraveling Glioblastoma Heterogeneity: Advancing Immunological Insights and Therapeutic Innovations.

Brain Sci. 2025-8-2

[6]
Checkpoint antibody receptor modified ARMed CAR T circumvents the suppressive immunome in GBM.

Front Immunol. 2025-7-31

[7]
Enhancing adoptive cell therapy: future strategies for immune cell radioprotection in neuro-oncology.

NPJ Precis Oncol. 2025-7-29

[8]
Targeting cancer stem cells with CAR-based immunotherapy: biology, evidence, and future directions.

Cancer Cell Int. 2025-7-28

[9]
Chimeric antigen receptor (CAR)-T-cell therapy for glioblastoma: what can we learn from the early clinical trials? A systematic review.

Neurooncol Adv. 2025-6-3

[10]
Advancing CAR-based cell therapies for solid tumours: challenges, therapeutic strategies, and perspectives.

Mol Cancer. 2025-7-7

本文引用的文献

[1]
Anti-BCMA/CD19 CAR T Cells with Early Immunomodulatory Maintenance for Multiple Myeloma Responding to Initial or Later-Line Therapy.

Blood Cancer Discov. 2023-3-1

[2]
Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination With Extension of Survival Among Patients With Newly Diagnosed and Recurrent Glioblastoma: A Phase 3 Prospective Externally Controlled Cohort Trial.

JAMA Oncol. 2023-1-1

[3]
PD1 Expression in EGFRvIII-Directed CAR T Cell Infusion Product for Glioblastoma Is Associated with Clinical Response.

Front Immunol. 2022

[4]
Immunologic Features in De Novo and Recurrent Glioblastoma Are Associated with Survival Outcomes.

Cancer Immunol Res. 2022-7-1

[5]
Preparing for CAR T cell therapy: patient selection, bridging therapies and lymphodepletion.

Nat Rev Clin Oncol. 2022-5

[6]
Human epigenetic and transcriptional T cell differentiation atlas for identifying functional T cell-specific enhancers.

Immunity. 2022-3-8

[7]
Engineered Removal of PD-1 From the Surface of CD19 CAR-T Cells Results in Increased Activation and Diminished Survival.

Front Mol Biosci. 2021-10-13

[8]
CD19-targeted chimeric antigen receptor T-cell therapy for CNS relapsed or refractory acute lymphocytic leukaemia: a post-hoc analysis of pooled data from five clinical trials.

Lancet Haematol. 2021-10

[9]
Pembrolizumab for B-cell lymphomas relapsing after or refractory to CD19-directed CAR T-cell therapy.

Blood. 2022-2-17

[10]
A Phase I Trial of Regional Mesothelin-Targeted CAR T-cell Therapy in Patients with Malignant Pleural Disease, in Combination with the Anti-PD-1 Agent Pembrolizumab.

Cancer Discov. 2021-11

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