Oral Presentation Australasian Cytometry Society 41st Annual Conference

Genetically modified T cells to treat advanced melanoma: defining the optimal phenotype for clinical success (24247)

Tessa Gargett 1 2 , Michael P Brown 1 2
  1. Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
  2. Translational Oncology Laboratory, Centre for Cancer Biolgoy, SA Pathology and University of South Australia, Adelaide, SA, Australia

Chimeric antigen receptor (CAR) T cells are genetically engineered to recognize tumour-associated antigens and have potent cytolytic activity against tumours and adoptive therapy with CAR T cells has been highly successful in haematological cancers. We are currently conducting the CARPETS study, a phase I clinical trial of third generation GD2-specific CAR T cells in metastatic melanoma patients at the Royal Adelaide Hospital. This trial was a world-first in using CAR T-cell therapy for melanoma, and in combining CAR T cells with standard kinase inhibitor-targeted therapy. So far, six patients have been treated safely with a further six to be recruited. Dose escalation has been completed and the treatment has been shown to be safe with no serious adverse events. However CAR T cells failed to persist beyond four weeks in five of six patients; the only patient to demonstrate long-term persistence was pre-treated with lympho-depleting chemotherapy. Our research suggests that GD2-specific CAR T cells have a predominately effector memory phenotype and a subset of CAR T cells upregulate and maintain PD-1 expression following antigen encounter. CAR T cells also demonstrate loss of function and increased susceptibility to activation-induced cell death with repeated stimulation. To counter this we have optimised CAR T cell manufacturing conditions to promote a more favourable T cell phenotype, and investigated a combination therapy approach with anti-PD1 monoclonal antibody, with the aim of promoting improved persistence and function of CAR T cells for the remaining CARPETS trial patients. Our aim is to improve CAR T cell efficacy for both melanoma and other solid cancers.