ny-eso-1 specific t cell therapy for patients with metastatic sarcoma seth m. pollack, md associate...
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NY-ESO-1 Specific T Cell Therapy for Patients with Metastatic Sarcoma
Seth M. Pollack, MD
Associate in Clinical Research, Fred Hutchinson Cancer Research Center
Acting Instructor, University of Washington
Cancer immunology review:
Sarcoma Cell
Tumor specific proteins are composed of peptides
CD8+ T cell
Tumor specific T cells recognize
peptides displayed in the MHC
complex..
MHC complex
Different HLA types:
EFFECTOR CELLS
Endogenous
Non-specific
LAK
TIL
Specific
CD8
CD4
Genetically modified
Re-directed specifity
TCR
CAR
Enhanced Function
Pollack SM and Yee C Innate Immune Regulation and Cancer Immunotherapy Springer 2012
EFFECTOR CELLS
Endogenous
Non-specific
LAK
TIL
Specific
CD8
CD4
Genetically modified
Re-directed specifity
TCR
CAR
Enhanced Function
Pollack SM and Yee C Innate Immune Regulation and Cancer Immunotherapy Springer 2012
Robbins et al., JCO 2011
Cancer Testis Antigens are Promising Targets
• In adults, only expressed in testis (some are also expressed in placenta)
• Expressed in many cancers
• Epigenetically regulated***
• Unknown biologic function
•Includes NY-ESO-1, LAGE-1, PRAME, MAGE-A3A: MAGE-A4 in tests
B: MAGE-C1 in fetal ovaryC: MAGE-A in trophoblastic placentaD: NY-ESO-1 in bladder cancer
Simpson AJ Nat Rev Cancer, 2005
NY-ESO-1 Is a Cancer Testis Antigen Frequently Expressed Target In Synovial Sarcoma
• NY-ESO stained 20/25 patients. • Staining homogonous in 14/20 patients
• 4 of the 5 patients without NY-ESO expression were biphasic phenotype (usually ssx-1)
• Targeted in the NCI Surgery Branch Study
Jungbluth AA et al., International Journal of Cancer, 2001
Computed tomography scans demonstrating tumor regression.
Robbins P F et al. JCO 2011;29:917-924
©2011 by American Society of Clinical Oncology
• We examined 25 Myxoid Liposarcoma tumors, all expressed NY-ESO-1 (100%)
• >70% of cases, homogenous
• In all but 2 case, patients would qualify for trials of NY-ESO-1 directed therapy based on staining.
• MRCL cell lines can be lysed using NY-ESO-1 specific effectors
• No other disease (including synovial sarcoma) expresses NY-ESO-1 with this frequency
Myxoid/ Round Cell Liposarcomas Always Express NY-ESO-1, Usually Homogenously
Pollack et al., Cancer 2012
Question: If Cancer Testis Antigens are epigenetically regulated, can sarcomas be induced to express them?
Decitabine induces NY-ESO-1 and MAGE-A3 in tumors from lung
cancer patients
• Patients on a phase I trial of decitabine for lung cancer
• Serial biopsies performed
• Analyzed retrospectively for CT Antigen Expression
• Increased expression following treatment
•This increase was sustained months after treatment
Schrump D S et al. Clin Cancer Res 2006;12:5777-5785
A minority of chondrosarcoma tumors express NY-ESO-1/LAGE-1.
•36% of tumors expressed either NY-ESO-1 or LAGE-1 at a level that might be targeted – could this be improved?
Pollack et al. Plos One, 2012
JJ FS 105KC SW13530.0001
0.0010.01
0.11
10
JJ FS 105KC SW13530.0001
0.0010.01
0.11
10
JJ FS 105KC SW13530.0001
0.0010.01
0.11
10
A. NY-ESO-1 Expression in Chondrosarcoma Cell Lines Relative to Mel375
B. PRAME Expression in Chondrosarcoma Cell Lines Relative to Mel375
C. LAGE-1s Expression in Chondrosarcoma Cell Lines Relative to JJ
Untreated 5-Aza-dC
Decitabine (5-Aza-dC) Treatment Increases mRNA Expression of NY-ESO-1, LAGE-1s and PRAME by qPCR.
Pollack et al. Plos One, 2012
10:1 20:1 40:1 MART-1-5.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
A. Percentage Lysis of FS Using NY-ESO-1/LAGE-1s Specific Effectors
FS FS + 5-Aza-dC
10:1 20:1 40:1 MART-10.00%
15.00%
30.00%
45.00%
60.00%
B. Percentage Lysis of JJ Using NY-ESO-1/LAGE-1s Specific Effectors
JJ JJ+5-Aza-dC
10:1 20:1 40:1 MART-1-5.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
C. Percentage Lysis of FS Using PRAME Specific Effectors
FS FS + 5-Aza-dC
10:1 20:1 40:1 MART-10.00%5.00%
10.00%15.00%20.00%25.00%30.00%35.00%
D. Percentage Lysis of JJ Using PRAME Specific Effectors
JJ JJ+5-Aza-dC
Lysis of the FS and JJ Cell Lines With and Without Decitabine (5-Aza-dC) Using NY-ESO-1/LAGE-1s and PRAME Specific Effector T
Cells
Pollack et al. Plos One, 2012
Question: Can we isolate and expand NY-ESO-1 specific T cells from sarcoma patients with NY-ESO-1 expressing tumors?
Generation of Autologous NY-ESO-1 Specific T Cells
Step 1: Leukapharesis
Step 2: Generation of dendritic cells
CD25 depletion (to reduce regulatory T cells)
Step 3: Stimulation of T cells using peptide pulsed dendritic cells
Step 4: Clinical grade sorting
Rapid Expansion
Examples of Clinical Grade Products
Sort and Expand
Sort and Expand
NY-ESO-1 Tetramer
CD8
+ 3 additional wells <1% tetramer +
Patient 2537-S02
Patient 2537-S04
+ 1 additional well <1% tetramer +
T2 un-
pulsed
T2 pulsed A3750.00%
20.00%
40.00%
60.00%
80.00%
100.00%
T2 un-
pulsed
T2 pulsed A3750.00%
10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%
100.00%
tetramer
Peptide Titration With NY-ESO-1 Specific Effectors:
Pros and cons of autologous vs. virally transfected NY-ESO-1 specificity?
FHCRC Protocol #2537
• Autologous NY-ESO-1 specific T cell therapy • Metastatic or unresectable Synovial Sarcoma
and Myxoid/round cell liposarcoma • Patient must have HLA type A*0201• 2 patients have been treated• 4 additional patients have T cell products
frozen • All finalized products kill tumor in vitro.• Lymphodelpetion with Cyclophosphamide as
is considered standard
-3 2 7 12 17 22 27 320
5
10
15
20
25
Day (infusion-day 0)
Adoptively transferred NY-ESO-1 Specific T cells Persist Following Infusion (from first patient treated)
% T
etra
mer
+ (%
of C
D8+
cel
ls)
6 wks 8 wks 10 wks
Pre-treatment Post-treatment (10 weeks)
Response in Large Right Upper Lobe Tumor
But the response was mixed …
• By IHC, few CD3+ cells could be seen in the tumor.• We expanded these few cells and a very small percentage were tetramer positive (a lower percentage than was in the peripheral blood). • These few cells could be sorted and expanded and remained functional.
NY-ESO-1 Tetramer
T2 unpulse
d
T2+N
Y-ESO
A375 tumor
526 tumor
0%10%20%30%40%50%60%70%80%
Sorted and Expanded Cells from Tumor Still Kill Tumor in
vitro
4/9/2012 7/2/2012
NY-ESO-1 Remains Post-Tx (20x)
Conclusion
• NY-ESO-1 is generally homogenously expressed in Myxoid/ Round Cell Liposarcoma tumors
• NY-ESO-1/LAGE-1s and PRAME can be up-regulated in Chondrosarcoma cell lines
• NY-ESO-1 specific T cells can be isolated and expanded from patients with NY-ESO-1 expressing sarcomas
Future Directions
• Expand to different HLA types, cancer testis antigens and sarcoma subtypes.
• Explore mechanisms of immune evasion in sarcoma tumors.
Acknowledgements:
FHCRC Immunology
Program:
Eric Farrar
Ivy Lai
Dawn Stief
Heather Sloan
Mentors: Cassian Yee, Stan Riddell
Robin Jones
Funding:
• SARC Career Development Award• Doug and Maggie Walker Foundation• Gilman Sarcoma Foundation
The SCCA Sarcoma Group
Chappie Conrad
Janet Eary
Doug Hawkins
Darin Davidson
Elizabeth Loggers
Gabrielle Kane
Edward Kim
Benjamin Hoch
Gary Mann
Venu Pillarisetty
Jennifer Hammilton
MSKCC/LudwigAchim JungbluthSacha Gnjatic