NW Symposium in Melanoma May 22, 2010 Adoptive T Cell Therapy Cassian Yee MD Member Program in...
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Transcript of NW Symposium in Melanoma May 22, 2010 Adoptive T Cell Therapy Cassian Yee MD Member Program in...
NW Symposium in MelanomaMay 22, 2010
Adoptive T Cell Therapy
Cassian Yee MD
Member
Program in Immunology
Fred Hutchinson Cancer Research Center
Tissue Expression Antigen Tumors Normal Tissues
Differentiation Antigens (overexpres sed) Tyrosinase Melanoma Melanocytes MART1/MelanA Melanoma Melanocytes gp100 Melanoma Melanocytes
Differentiation Antigens (normally expr.) Prostate specific an tigens Prostate Cancer Prostate CD20, Idiotype B cell malignancies B cells
Cancer-Testis Antigens MAGE-1, MAGE-3 Melanoma, Lung, Others Testis, Placenta NY-ESO-1 Breast, Ovarian, Lung,
Melanoma, Others Testis, Placenta
Oncofetal Antigens CEA Colon Cancer, Others Liver, Others AFP Liver Cancer
Viral Antigens EBV NPC, Hodkgin’s, LPD Mutated Antigens
CASP-8 Head and Neck Cancer - CDK4-kinase, MUM-3 Melanoma - Beta-catenin Melanoma, Lung, Others -
Minor Histocompatibility Antigens HA-1, HA-2 Leukemia, RCC, Breast *allogeneic
• Immune evasion
• T cell frequency : Tumor burden
Possible Reasons For Failure of Tumor Immune Surveillance
Highly functional T cells
More of them
Study in Patients with Advanced Melanoma
Treated with T Cell Therapy
Recruited patients with metastatic disease progressive failing 2nd and 3rd attempts to treat cancer
Study in Patients with Advanced Melanoma
Treated with T Cell Therapy
• 30% Failed
• 30% Partial Response
• 30% Stabilized Response
• 10% near Complete Response
3 to > 30 months
Increase 'space' for transferred T cellsEliminate 'suppressor cells'
Supply Growth FactorsIncrease 'space' for transferred T cells
Eliminate 'suppressor cells'Supply Growth Factors
Lymphodepletionbuilding a better environment
PROTOCOL # 2140Adoptive T Cell Therapy following Cyclophosphamide Lymphodepletion
Objectives : Eligibility Criteria : - Evaluate Safety - Stage IV (Metastatic) - Evaluate T Cell Persistence - HLA-A2 - Evaluate anti-tumor efficacy
T Cell Infusion: - Antigen-specific CD8+ T cell clones - Targeting MART-1, gp100 - Dose: 1010 cells / m2
CY60 mg/kg x 2
Low-Dose IL-2 (250,000 U s.c q12 h)
Clinical Response
Patient Target Toxicity Persistence Disease Sites Response
2140-1 Tyrosinase F,N,R >290 days Cervical,supraclavicular LN, Chest Wall, BreastPulmonary nodules
MR
2140-2 Tyrosinase F 16 days Mediastinal, Pulmonary nodules PD
2140-3 gp100 F,N,R >85 days Mesenteric LN, scapular subcutaneous dz
CR (> 12 mths)
2140-4 MART-1 F, N, R n.d. Pulmonary, inguinal, subcutaneous
SD
2140-5 MART-1 F, N,R n.d. Right and left kidneys, adrenal, liver
PR
2140-6 MART-1 F, N, R n.d. Mediastinal, supra clavicular, mammary chain, periportal, portacaval nodes.
PR
Future of Adoptive T Cell Therapy
• LATE-STAGE DISEASE
• EARLY-STAGE DISEASE
• COMBINATION THERAPY
• WHICH CANCER TYPES?
Tissue Expression Antigen Tumors Normal Tissues
Differentiation Antigens (overexpres sed) Tyrosinase Melanoma Melanocytes MART1/MelanA Melanoma Melanocytes gp100 Melanoma Melanocytes
Differentiation Antigens (normally expr.) Prostate specific an tigens Prostate Cancer Prostate CD20, Idiotype B cell malignancies B cells
Cancer-Testis Antigens MAGE-1, MAGE-3 Melanoma, Lung, Others Testis, Placenta NY-ESO-1 Breast, Ovarian, Lung,
Melanoma, Others Testis, Placenta
Oncofetal Antigens CEA Colon Cancer, Others Liver, Others AFP Liver Cancer
Viral Antigens EBV NPC, Hodkgin’s, LPD Mutated Antigens
CASP-8 Head and Neck Cancer - CDK4-kinase, MUM-3 Melanoma - Beta-catenin Melanoma, Lung, Others -
Minor Histocompatibility Antigens HA-1, HA-2 Leukemia, RCC, Breast *allogeneic
31
Tissue Expression Antigen Tumors Normal Tissues
Differentiation Antigens (overexpres sed) Tyrosinase Melanoma Melanocytes MART1/MelanA Melanoma Melanocytes gp100 Melanoma Melanocytes
Differentiation Antigens (normally expr.) Prostate specific an tigens Prostate Cancer Prostate CD20, Idiotype B cell malignancies B cells
Cancer-Testis Antigens MAGE-1, MAGE-3 Melanoma, Lung, Others Testis, Placenta NY-ESO-1 Breast, Ovarian, Lung,
Melanoma, Others Testis, Placenta
Oncofetal Antigens CEA Colon Cancer, Others Liver, Others AFP Liver Cancer
Viral Antigens EBV NPC, Hodkgin’s, LPD Mutated Antigens
CASP-8 Head and Neck Cancer - CDK4-kinase, MUM-3 Melanoma - Beta-catenin Melanoma, Lung, Others -
Minor Histocompatibility Antigens HA-1, HA-2 Leukemia, RCC, Breast *allogeneic
Adoptive Therapy following Lymphodepletion
FLU25 mg/m2 x
5
HD IL-2720K u/kg TID
CY60 mg/kg x 2
TBI High-Dose IL-2 (600,000 u./kg q8)Low-Dose IL-2 (250,000 U s.c q12 h)
Adoptive Therapy following Cytoxan Lymphodepletion Protocol 2140
HD IL-2720K u/kg TID
CY60 mg/kg x 2
High-Dose IL-2 (600,000 u./kg q8)Low-Dose IL-2 (250,000 U s.c q12 h)
Isolate/Enrich Clone/Select
Expand
Translational Strategies to Augment the CD8 Effector Response
CD8-FITC
Te
t-P
E
Genetically Modify
Pre-infusion Immunomodulation
Post-infusion Immunomodulation
Intrinsic
Extrinsic
Phenotype- CD8/CD4- Memory phenotype
Cytokine modulation
Lymphodepletion- Chemotherapy/TBI
Cytokine help- Low-dose IL-2- High-dose IL-2- Other γ-chain receptor cytokines
Vaccine + adoptive therapy
TCR Chimeric receptor Costimulatory/Inhbitory modification Suicide gene
Ê CD4
Fludarabine
Hematol Oncol Clin North Am. 2006 Jun;20(3):711-3