Dual IGF1R/IR inhibitors in combination with GD2-CAR T-cells display a potent anti-tumor activity in diffuse midline glioma H3K27M-mutant

BackgroundDiffuse midline gliomas (DMG) H3K27M-mutant, including diffuse intrinsic pontine glioma (DIPG), are pediatric brain tumors associated with grim prognosis. Although GD2-CAR T-cells demonstrated significant anti-tumor activity against DMG H3K27M-mutant in vivo, a multimodal approach may be needed to more effectively treat patients. We investigated GD2 expression in DMG/DIPG and other pediatric high-grade gliomas (pHGG) and sought to identify chemical compounds that would enhance GD2-CAR T-cell anti-tumor efficacy.MethodsImmunohistochemistry in tumor tissue samples and immunofluorescence in primary patient-derived cell lines were performed to study GD2 expression. We developed a high-throughput cell-based assay to screen 42 kinase inhibitors in combination with GD2-CAR T-cells. Cell viability, western blots, flow-cytometry, real time PCR experiments, DIPG 3D culture models, and orthotopic xenograft model were applied to investigate the effect of selected compounds on DIPG cell death and CAR T-cell function.ResultsGD2 was heterogeneously, but widely, expressed in the tissue tested, while its expression was homogeneous and restricted to DMG/DIPG H3K27M-mutant cell lines. We identified dual IGF1R/IR antagonists, BMS-754807 and linsitinib, able to inhibit tumor cell viability at concentrations that do not affect CAR T-cells. Linsitinib, but not BMS-754807, decreases activation/exhaustion of GD2-CAR T-cells and increases their central memory profile. The enhanced anti-tumor activity of linsitinib/GD2-CAR T-cell combination was confirmed in DIPG models in vitro, ex vivo, and in vivo.ConclusionOur study supports the development of IGF1R/IR inhibitors to be used in combination with GD2-CAR T-cells for treating patients affected by DMG/DIPG and, potentially, by pHGG.     

Combination of CRAFITY score with Alpha-fetoprotein response predicts a favorable outcome of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma

Immune checkpoint inhibitors (ICIs) with atezolizumab plus bevacizumab are promising agents for unresectable hepatocellular carcinoma (HCC). We tried to guide the treatment based on recent developed CRAFITY score combining with on-treatment AFP response. Eighty-nine patients who received atezolizumab plus bevacizumab regardless of as a first-line therapy or not for unresectable HCC were enrolled for analyses. Radiologic evaluation was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). The objective response rate (ORR) and disease control rate (DCR) were 25.0% and 65.5%, respectively. Multivariate analysis showed that low CRAFITY score (AFP<100 ng/ml or CRP<10 mg/l) and satisfactory AFP response at 6 weeks (≥75% decrease or ≤10% increase from baseline) were independent factors determining good overall survival (OS) (hazard ratio [HR]=0.143, P=0.002 & HR=0.337, P=0.031), progression-free survival (PFS) (HR=0.419, P=0.022 & HR=0.429, P=0.025) and good responder (odds ratio [OR]=1.763, P=0.044 & OR=3.881, P=0.011). Patients were further divided into three classes by combination of CRAFITY score and AFP response at 6 weeks [The CAR (CRAFITY score and AFP-Response) classification)]: low CRAFITY score with satisfactory AFP response at 6 weeks (class I), either high CRAFITY score or unsatisfactory AFP response at 6 weeks (class II) and high CRAFITY score together with unsatisfactory AFP response at 6 weeks (class III). ORR was 35.0%, 18.2%, and 0% in class I, II and III patients, respectively (overall P=0.034). Patients in the class I had the best OS and PFS, followed by class II and class III (median OS: not reached vs. 11.1 vs. 4.3 months, log-rank P<0.001; median PFS: 7.9 vs. 6.6 vs. 2.6 months, log-rank P=0.001). Combination CRAFITY score and AFP response at 6 weeks with AUROC predicts OS and tumor response to be 0.809 and 0.798, respectively, better than either CRAFITY score (0.771 & 0.750) or AFP response at 6 weeks (0.725 & 0.680) alone. In conclusions, the CAR classification which combining CRAFITY score and AFP response at 6 weeks provides a practical guidance for atezolizumab plus bevacizumab therapy in unresectable HCC patients.     

CAR T细胞治疗的现状与临床应用前景

嵌合抗原受体T细胞（CAR T）疗法是肿瘤过继免疫治疗的新手段。CAR T细胞疗法治疗B细胞急性淋巴细胞白血病（B ALL）的完全缓解率高达90％。然而,目前CAR T细胞疗法在血液肿瘤的治疗过程中尚存在脱靶效应、毒副作用、体内持续时间短与复发率高等问题。此外,在CAR T细胞治疗实体瘤方面的安全性和有效性虽已得到证实,但疗效还有待提高。本文对近年来CAR T细胞治疗的研究进展及该领域中亟需解决的问题作一分析与展望。     

肿瘤过继性细胞免疫治疗研究进展

肿瘤的过继性细胞免疫治疗作为生物治疗手段的一种,已成为国内外研究的热点。与传统疗法相比,过继性细胞免疫治疗不仅可以直接杀灭肿瘤,而且能调动机体自身的免疫功能来发挥抑制肿瘤的作用。作者就肿瘤的过继性细胞免疫治疗作一综述。     

基于嵌合抗原受体的肿瘤免疫治疗的研究进展

近来关于嵌合抗原受体(chimeric antigen receptor,CAR)修饰T细胞在治疗包括淋巴瘤、白血病、脑胶质瘤、黑色素瘤、肺癌、前列腺癌、胰腺癌及卵巢癌等肿瘤所取得成绩令人振奋。CAR是利用基因工程将能够与肿瘤抗原结合的受体与跨细胞膜的部分和细胞内信号转导的部分结合起来形成的一种新型受体,它可脱离主要组织相容性复合体的限制单独执行杀伤细胞的功能。CAR修饰T细胞因其独特的设计和强效的抗肿瘤作用受到人们的追捧。作者就CAR修饰T细胞在临床治疗中的应用、遇到的问题和对应策略作一综述。     

5-HT2A/D2 受体平衡拮抗剂NH809抗精神分裂症作用的初步研究

目的：考察5-HT2A/D2 受体平衡拮抗剂NH809 体内抗精神分裂症药理学作用。方法：采用地卓西平马来酸盐（0.3 mg·kg^-1,ip）诱发小鼠高活动模型、阿扑吗啡（1 mg·kg^-1,sc）诱导小鼠攀爬模型及大鼠条件回避反应（conditioned avoidance response,CAR）实验,评估NH809 体内抗精神分裂症的作用,并与阳性药利培酮进行比较。结果：在地卓西平马来酸盐诱发小鼠高活动模型、阿扑吗啡诱导小鼠攀爬行为及大鼠条件回避反应体内动物 模型上,NH809 具有剂量相关的抑制作用,其ED50 分别为0.04、0.05 和0.24 mg·kg^-1;利培酮在这三个模型上的ED50 分别为0.06、0.68 和0.60 mg·kg^-1。结论：NH809 对多个精神分裂症动物模型具有显著的药理学作用,且体内活性优于利培酮。     

Low-Dose Radiation Conditioning Enables CAR T Cells to Mitigate Antigen Escape

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Strategies for enhancing adoptive T-cell immunotherapy against solid tumors using engineered cytokine signaling and other modalities

Introduction: Cancer therapy has been transformed by the demonstration that tumor-specific T-cells can eliminate tumor cells in a clinical setting with minimal long-term toxicity. However, significant success in the treatment of leukemia and lymphoma with T-cells using native receptors or redirected with chimeric antigen receptors (CARs) has not been recapitulated in the treatment of solid tumors. This lack of success is likely related to the paucity of costimulatory and cytokine signaling available in solid tumors, in addition to a range of inhibitory mechanisms.

Areas covered: We summarize the latest developments in engineered T-cell immunotherapy, describe the limitations of these approaches in treating solid tumors, and finally highlight several strategies that may be useful in mediating solid tumor responses in the future, while also ensuring safety of engineered cells.

Expert opinion: CAR-T therapies require further engineering to achieve their potential against solid tumors. Facilitating cytokine signaling in CAR T-cells appears to be essential in achieving better responses. However, the engineering of T-cells with potentially unchecked proliferation and potency raises the question of whether the simultaneous combination of enhancements will prove safe, necessitating continued advancements in regulating CAR-T activity at the tumor site and methods to safely switch off these engineered cells.