University of Lausanne and Ludwig Institute

Transcription

1 T Cell Adoptive Therapy Approaches, Challenges and Solutions for Beating Cancer George Coukos, MD, PhD University of Lausanne and Ludwig Institute

2

3

4 Examples of Clinical Studies Targeting Solid Tumors by ACT Fousek & Ahmed, Clin Canc Res, 2015

5

6 Adoptive Immunotherapy Using Natural T Cells

7 Park, Rosenberg & Morgan, Trends Biotechnol 2011

8 The generation of anti-tumour T cells used for adoptive cell therapy Natural TILs Metastatic melanoma 13 patients=> 45% RECIST (Science 2002) 35 patients=> 51% RECIST (JCO 2005) 93 patients => 72% RECIST 22% complete response 20% cure (Clin Ca Res 2011) Nature reviews cancer 8, , 2008

9 TIL Therapy advanced melanoma patient 2-weeks post treatment Dr. Steven Rosenberg, NCI

10 TIL Therapy

11 Success of Adoptive Therapy Using TILs From July 2002 to July 2007, 787 tumors from 402 patients Melanoma were processed for TIL. Active, specific TILs Lung were identified in 269 patients (67%), Head leading & to Neck the eventual treatment of 107 patients (27%). Cervical Ovarian Breast Goff SL et al. J Immunother 2010 Gastric Hepatocellular Pancreatic Colon Multiple myeloma Rosenberg S A et al. Clin Cancer Res 2011

12 Challenges of TIL Therapy ACT with TILs achieves 49-72% objective response rates Patients have to undergo surgery T cells are functionally exhausted TILs are of unknown antigen specificity The immune system tolerates self-proteins (TCR may not be of optimal affinity) Need for IL-2 and lymphodepletion (toxic) June et al, J Clin Invest, 2007 Dudley et al, J Clin Oncol, 2008 Yee et al, Cancer J, 2010 Morgan et al, Cancer J, 2010 Johnson, Blood, 2009

13 Lausanne TIL study TIL Dose escalation Durvalumab q 2wk Flu/Cy IL-2 days till progression or toxicity Olivier Michielin Angela Orcurto Krisztian Homicsko Gael Deplanque Lana Kandalaft Urania Dafni

14 Dudley M E et al. JCO 2013;31:

15 Antigen specific TIL therapy for melanoma Kelderman et al European Journal of Immunology 2016

16 Identification and validation of somatic mutations Identification of Mutanome specific TILs Biochemical validation of HLA binding of mutanome peptides In silico peptides prediction (NetMHC) Biochemical peptides validation (refolding assay) T cells screening with pools of validated candidate peptides Microtiter plates are coated with HLA-peptide complexes Washing to remove the original peptide and β2- microglobulin Addition of biotinylated β2m and candidate peptides Staining with PEstreptavidin effective peptide binding is determined by reading PE fluorescence Single epitope(s) identification and validation

17 Tumor-specific T cell therapy Lung cancer Extraction of TILs Identification and selection of mutation-specific TILs Solange Peters Tu Nguyen Angela Orcurto Krisztian Homicsko Lana Kandalaft Alex Harari Urania Dafni George Coukos Expansion Transfer

18 Adoptive Immunotherapy Using Engineered T Cells

19 10d

20 CAR T cells comprise scfv-mediated Tumor Cell Specificity Along with Signal 1 (CD3z) and Signal 2 (costimulatory domains) Borrowed from Natural T cell Activation Kershaw et al, Nat Rev Cancer, 2013

21 Tumor specific T cell receptors are often of sub optimal affinity due to thymic negative selection Affinity/Avidity of TCRs and Functionality Low (100 μm) TCR AFFINITY for pmhc High (1 μm) No recognition Self antigens (tumor Ag: Melan-A, NY-ESO-1) Foreign antigens (viral & other pathogenic Ag) Crossreactivity Autoimmunity Anergy Solution: In silico modeling or library-based approaches (phage, yeast ) can be used to select for affinity-optimized TCR for gene transfer.

22 TCR chain mispairingoccurs when an introduced chain pairs with an endogenous one. To avoid the risk of autoreactivity as a result of such hybrid TCRs approaches have been taken including the introduction of a non-native disulfide bridge to favor natural pairing, and the use of Zinc fingers and CRISPR-based methods to delete the endogenous TCR genes.

23 Melanoma Regression in Patients after Transfer of Genetically Engineered Lymphocytes (TCR) Science 314, , 2006

24 Examples of Clinical Responses UPN R/B R/B B CARs WBC ALC UPN 01 Day -21 Cells (x10-3 /mm 3 ) Corticosteroids started Day UPN 03 Days from Infusion Pre-Therapy 3 Months David Porter, MD N Engl J Med 365:725, 2011

25 The CD19 CAR T Cell Success Story for relapsed ALL and CLL Complete remission and longterm responses in up to 90% of acute lymphoblastic leukemia (ALL) patients and 45% of chronic lymphocytic leukemia (CLL) patients. Emily Whitehead On target side effects include B cell aplasia and cytokine release syndrome. Maud et al, NEJM 2015 & Blood 2015

26 Summary of CART19 Efficacy in ALL (n=30) Case mix on phase I: 25 pediatric and 5 adult month OS: 78% (95% CI: 64,95) Probability Maude NEJM N: Days since infusion CR: 27/30 (90%) PR/NR: 3/30 (10%)

27 T cell-based Clinical Trials in the USA versus the EU de Witte et al, Cancer Immunol Immunother 2015

28 Receptor Design

29 Components to CAR Design Dotti et al, Immunol Rev 2014

30 Receptor Design: Chimeric Antigen Receptors Maus et al, Blood, 2014

31 Vector/Gene-Engineering Approach

32 Gene-Engineering Appraoches to Express CAR and TCR Park et al, Trends in Bioetch, 2011

33 Cutting Edge: Genome Editing Approaches based on DNA-targeting Proteins and DNA-targeting RNAs ZFN (ZFP Nucleases) are eukaryotic DNA binding proteins TALENS (TAL Effector Nucleases) are bacterial DNA binding proteins CRISPR Cas9 (clustered regularly interspaced short palindromic repeats); Cas9 nuclease binds to a short complementary RNA providing DNAtargeting specificity and to a trans-activating crrna Lentivirusmediated RNA interferences (RNAi; usually short hairpin (sh)rna) is efficient in gene-silencing in T cells but the constant production of shrnacan interfere with endogenous mirna biogenesis and de-regulate gene expression. Lloyd et al, Frontiers in Immun 2013

34 Cutting Edge: Off-the-Shelf T cell Therapy June month old Layla with ALL has been treated in London for the first time with ever with off the shelf allogenic TALEN gene-edited CD19 CAR T cells from Cellectis (UCART19: TCR expression is disrupted and CD52 is targeted so that the donor cells are insensitive to Alemtzumab)

35 T cell Co-Engineering Strategies

36 Strategies to Improve Adoptive Transfer of Tumor Specific T Cells Using Genetic Modification Ho, Greenberg et al, Cancer Cell (2003)

37 Examples of Immune Checkpoint Genome-Editing Targets Lloyd et al, Frontiers in Immun 2013

38 CART19 Toxicities B cell aplasia observed in all responding patients to date managed with replacement therapy Tumor lysis syndrome (TLS) may be delayed for 20 to 50 days post infusion Cytokine release syndrome (CRS) reversible, on-target toxicity Severity related to tumor burden Macrophage activation syndrome (HLH / MAS) elevated serum ferritin (>500,000 ng/ml), CRP, D-dimer elevated cytokines: IL-6, IFN-gamma Reversed with tocilizumab

39 Safety Approaches

40 Cutting Edge: Remote Control CAR T Cells

41 A specialized program to engineer, manufacture and deliver the next individualized immune therapies

42 Establishment of CHUV ION Service Clinical Immuno oncology fellowship positions available! Immuno-radiotherapy combina ons 2 to 3 years of clinical and research training RTH Completed training in internal medicine and medical oncology Contact: Pharma Drugs & Combina ons Phase II / III ONM george.coukos@chuv.ch ION HEM Pharma Drugs & Combina ons Phase II / III & anne.progin@chuv.ch FIH / Phase I Pharma Drugs Cell Therapy

43 Recruiting: Fellowship in immuno-oncology Thank you!!