Potent antitumor efficacy of anti-GD2 CAR T cells in H3-K27M+ diffuse midline gliomas

CW Mount, RG Majzner, S Sundaresh, EP Arnold… - Nature medicine, 2018 - nature.com
CW Mount, RG Majzner, S Sundaresh, EP Arnold, M Kadapakkam, S Haile, L Labanieh
Nature medicine, 2018nature.com
Diffuse intrinsic pontine glioma (DIPG) and other diffuse midline gliomas (DMGs) with
mutated histone H3 K27M (H3-K27M),,,–are aggressive and universally fatal pediatric brain
cancers. Chimeric antigen receptor (CAR)-expressing T cells have mediated impressive
clinical activity in B cell malignancies,,–, and recent results suggest benefit in central
nervous system malignancies,–. Here, we report that patient-derived H3-K27M-mutant
glioma cell cultures exhibit uniform, high expression of the disialoganglioside GD2. Anti …
Abstract
Diffuse intrinsic pontine glioma (DIPG) and other diffuse midline gliomas (DMGs) with mutated histone H3 K27M (H3-K27M), , , – are aggressive and universally fatal pediatric brain cancers. Chimeric antigen receptor (CAR)-expressing T cells have mediated impressive clinical activity in B cell malignancies, , –, and recent results suggest benefit in central nervous system malignancies, –. Here, we report that patient-derived H3-K27M-mutant glioma cell cultures exhibit uniform, high expression of the disialoganglioside GD2. Anti-GD2 CAR T cells incorporating a 4-1BBz costimulatory domain demonstrated robust antigen-dependent cytokine generation and killing of DMG cells in vitro. In five independent patient-derived H3-K27M+ DMG orthotopic xenograft models, systemic administration of GD2-targeted CAR T cells cleared engrafted tumors except for a small number of residual GD2lo glioma cells. To date, GD2-targeted CAR T cells have been well tolerated in clinical trials, –. Although GD2-targeted CAR T cell administration was tolerated in the majority of mice bearing orthotopic xenografts, peritumoral neuroinflammation during the acute phase of antitumor activity resulted in hydrocephalus that was lethal in a fraction of animals. Given the precarious neuroanatomical location of midline gliomas, careful monitoring and aggressive neurointensive care management will be required for human translation. With a cautious multidisciplinary clinical approach, GD2-targeted CAR T cell therapy for H3-K27M+ diffuse gliomas of pons, thalamus and spinal cord could prove transformative for these lethal childhood cancers.
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