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During iwCLL, on 15th May 2017, the “Additional Therapies for the Relapsed/Refractory CLL Patient” session took place and was co-chaired by Michael Keating (MD Anderson Cancer Center) and Jacqueline Barrientos (The Feinstein Institute for Medical Research).
“Anti-CD19 CAR-T Cell Therapy With Defined T-Cell Subsets for Ibrutinib-Refractory CLL” was a presentation given during this session by David G. Maloney, MD, PhD, from the Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Maloney began by explaining that CAR-T cells produced from distinct T-cell subsets differ in potency. NSG mice bearing Raji tumors (0.5x106 tumor cell inoculation; day 0) were treated with human CAR-T cells manufactured from distinct T-cell subsets (on day 7). CAR-T cells produced from CD8+ TCM cells were highly potent (Sommermeyer et al. 2015).
Engineering selected T-cell subsets could enhance potency and allow delivery of the same cell product in all patients, potentially providing more uniform data on dose response and toxicity.
Pre-clinical studies have established that a defined composition of CD8+ TCM derived and CD4+ derived CAR T-cells provides optimal potency.
The talk then focused on the outline of the phase I/II study of JCAR014 in adult B-cell ALL, NHL, and CLL patients (NCT01865617).
As of 9/1/16, 136 patients had been treated: ALL = 48, NHL = 64, and CLL = 24.
Dose Level |
Cells/kg |
---|---|
1 |
2x105 EGFRt+ |
2 |
2x106 EGFRt+ |
3 |
2x107 EGFRt+ |
Lymphodepletion and JCAR014 immunotherapy in high-risk CLL patients:
Treatment |
N=24 |
---|---|
Lymphodepleting chemotherapy |
|
Cyclophosphamide/fludarabine (Cy/Flu) |
21 (87%) |
Non-Cy/Flu |
3 (13%) |
CAR-T cell manufacturing |
|
CD8+ central memory and CD4+ |
7 (29%) |
CD8+ all subsets and CD4+ |
17 (71%) |
CD19 CAR-T cell dose level |
|
DL1 (2x105 EGFRt+ cells/kg) |
4 (17%) |
DL2 (2x106 EGFRt+ cells/kg) |
19 (79%) |
DL3 (2x107 EGFRt+ cells/kg) |
1 (4%) |
Cycles |
|
Single cycle |
18 (75%) |
Outpatient lymphodepletion and CAR-T cells |
18 (75%) |
Second cycle for residual disease or relapse |
6 (25%) |
Maloney then asked “can IGH sequencing of the marrow at 4 weeks after JCAR014 identify patients with better outcomes?”
Additionally, higher JCAR014 counts in the blood after infusion were associated with better bone marrow response in high-risk CLL. Patients with a higher peak CD3+/EGFRt+ CAR-T cell count in the blood had a reduced hazard of progression or death (HR, 0.56; 95% CI, 0.34–0.93; P = 0.025).
Maloney concluded that in high-risk CLL patients CD19 CAR-T cells of defined composition (JCAR014) can be administered with an acceptable early toxicity profile. JCAR014 and Cy/Flu lymphodepletion shows a high-level or anti-tumor activity as measured by:
Deep marrow clearance by IGHseq after JCAR014 provides early signs of durable responses with 100% PFS and OS.
Lastly, Maloney presented evidence that ROR1 presents as a novel target for CAR-T cell therapy for CLL, MCL, and solid tumors as it is highly expressed on the surface of malignant B-cells:
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