Article
作者: Tonn, Torsten ; Senft, Christian ; Röder, Jasmin ; Macas, Jadranka ; Plate, Karl H ; Rieger, Michael A ; Langen, Karl-Josef ; Mildenberger, Iris C ; Zhang, Congcong ; Ihrig, Kristina ; Herrmann, Eva ; Straßheimer, Florian ; Forster, Marie-Therese ; Bonig, Halvard ; Herkt, Stefanie ; Rödel, Franz ; Opitz, Corinna ; Steinbach, Joachim P ; Strecker, Maja I ; Steidl, Eike ; Müller, Elvira ; Hattingen, Elke ; Nowakowska, Paulina ; Romanski, Annette ; Weber, Katharina J ; Wlotzka, Karolin ; Wels, Winfried S ; Burger, Michael C ; George, Rosemol ; Cakmak, Pinar ; Reiss, Yvonne ; Lun, Jennifer H ; Schupp, Jonathan ; Harter, Patrick N ; Zeiner, Pia S
Background:Glioblastoma (GB) is incurable at present without established treatment options for recurrent disease. In this phase I first-in-human clinical trial we investigated safety and feasibility of adoptive transfer of clonal chimeric antigen receptor (CAR)-NK cells (NK-92/5.28.z) targeting HER2, which is expressed at elevated levels by a subset of glioblastomas.
Methods:Nine patients with recurrent HER2-positive GB were treated with single doses of 1 × 107, 3 × 107, or 1 × 108 irradiated CAR-NK cells injected into the margins of the surgical cavity during relapse surgery. Imaging at baseline and follow-up, peripheral blood lymphocyte phenotyping and analyses of the immune architecture by multiplex immunohistochemistry and spatial digital profiling were performed.
Results:There were no dose-limiting toxicities, and none of the patients developed a cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Five patients showed stable disease after relapse surgery and CAR-NK injection that lasted 7 to 37 weeks. Four patients had progressive disease. Pseudoprogression was found at injection sites in 2 patients, suggestive of a treatment-induced immune response. For all patients, median progression-free survival was 7 weeks, and median overall survival was 31 weeks. Furthermore, the level of CD8+ T-cell infiltration in recurrent tumor tissue prior to CAR-NK cell injection positively correlated with time to progression.
Conclusions:Intracranial injection of HER2-targeted CAR-NK cells is feasible and safe in patients with recurrent GB. 1 × 108 NK-92/5.28.z cells was determined as the maximum feasible dose for a subsequent expansion cohort with repetitive local injections of CAR-NK cells.