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