PSCA-CAR T cell therapy in metastatic castration-resistant prostate cancer: a phase 1 trial
- Creators
- Dorff, Tanya B.
- Blanchard, M. Suzette
- Adkins, Lauren N.
- Luebbert, Laura
- Leggett, Neena
- Shishido, Stephanie N.
- Macias, Alan
- Del Real, Marissa M.
- Dhapola, Gaurav
- Egelston, Colt
- Murad, John P.
- Rosa, Reginaldo
- Paul, Jinny
- Chaudhry, Ammar
- Martirosyan, Hripsime
- Gerdts, Ethan
- Wagner, Jamie R.
- Stiller, Tracey
- Tilakawardane, Dileshni
- Pal, Sumanta
- Martinez, Catalina
- Reiter, Robert E.
- Budde, Lihua E.
- D'Apuzzo, Massimo
- Kuhn, Peter
- Pachter, Lior1
- Forman, Stephen J.
- Priceman, Saul J.
Abstract
Despite recent therapeutic advances, metastatic castration-resistant prostate cancer (mCRPC) remains lethal. Chimeric antigen receptor (CAR) T cell therapies have demonstrated durable remissions in hematological malignancies. We report results from a phase 1, first-in-human study of prostate stem cell antigen (PSCA)-directed CAR T cells in men with mCRPC. The starting dose level (DL) was 100 million (M) CAR T cells without lymphodepletion (LD), followed by incorporation of LD. The primary end points were safety and dose-limiting toxicities (DLTs). No DLTs were observed at DL1, with a DLT of grade 3 cystitis encountered at DL2, resulting in addition of a new cohort using a reduced LD regimen + 100 M CAR T cells (DL3). No DLTs were observed in DL3. Cytokine release syndrome of grade 1 or 2 occurred in 5 of 14 treated patients. Prostate-specific antigen declines (>30%) occurred in 4 of 14 patients, as well as radiographic improvements. Dynamic changes indicating activation of peripheral blood endogenous and CAR T cell subsets, TCR repertoire diversity and changes in the tumor immune microenvironment were observed in a subset of patients. Limited persistence of CAR T cells was observed beyond 28 days post-infusion. These results support future clinical studies to optimize dosing and combination strategies to improve durable therapeutic outcomes. ClinicalTrials.gov identifier NCT03873805.
Copyright and License
© The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Acknowledgement
This study was funded by a 2017 Prostate Cancer Foundation Challenge Award (S.J.P. and S.J.F.) and an NCI SPORE Award (P50CA092131). Studies reported in this publication were also supported by the Doug and Rhonda Collier Foundation Fund, the Fiterman Family Foundation Fund and the Borstein Foundation Fund. Work performed in the GMP facility and the COH Pathology Core was supported by the National Cancer Institute of the National Institutes of Health under grant no. P30CA033572. We thank staff at the Analytical Pharmacology Core Facility for their assistance in performing correlatives assays and the T Cell Therapeutics Research Laboratories and the Center for Biomedicine and Genetics for CAR T cell manufacturing and product release. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes.
Contributions
T.B.D., M.S.B., L.N.A., L.L., N.L., S.N.S., A.M., M.M.D.R., G.D., C.E., J.P.M., R.R., J.P., A.C., H.M., E.G., J.R.W., T.S., D.T., S.P., C.M., R.E.R., L.E.B., M.D., P.K., L.P., S.J.F. and S.J.P. participated in the design, execution and data analysis and/or interpretation of the reported results. T.B.D., M.S.B., L.N.A., L.L., N.L., S.N.S., A.M., M.M.D.R., G.D., J.P.M., M.D., P.K., L.P., S.J.F. and S.J.P. contributed to the acquisition of and analysis of data. L.L., N.L., R.R., L.P. and S.J.P. designed, executed and interpreted the scRNA-seq data analysis. S.J.P. and T.B.D. wrote the paper. T.B.D., S.J.F. and S.J.P. supervised all aspects of the study. All authors reviewed, edited and/or advised on the paper.
Data Availability
All required clinical data have been uploaded to ClinicalTrials.gov. All requests for raw and analyzed data and materials should be addressed to the corresponding authors and will be reviewed by the institution to verify whether the request is subject to any intellectual property or confidentiality obligations. Patient data may be subject to patient confidentiality. Any data and materials that can be shared will be released via a material transfer agreement. Source data are provided with this paper.
Extended Data Fig. 1 PSCA-CAR T cell product characterization.
Code Availability
A description of the methods and the code used to process and analyze the scRNA-seq and TCR-seq data is available at https://github.com/pachterlab/DBALLSMRDMCMGWSTPMBDKPFP_2023. The TCR and single-cell RNA-seq data can be accessed at https://www.dropbox.com/scl/fo/rhgr2y28az1e2h0avaj0l/h?rlkey=6a4wlnus0png19mb80g42uja1&dl=0 (using password ‘coh_128781’).
Conflict of Interest
T.B.D. is a consultant for AstraZeneca and Janssen. S.J.P. and S.J.F. are scientific advisors to and receive royalties from Mustang Bio. S.J.P. is also a scientific advisor and/or receives royalties from Imugene, Adicet Bio, Port Therapeutics and Celularity. S.J.P. and S.J.F. are listed as co-inventors on a patent on chimeric antigen receptors targeted to PSCA, which is owned by the City of Hope. The other authors declare no competing interests.
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Additional details
- ISSN
- 1546-170X
- Prostate Cancer Foundation
- 2017 Prostate Cancer Foundation Challenge Award
- National Institutes of Health
- P50CA092131
- National Institutes of Health
- P30CA033572
- Caltech groups
- Division of Biology and Biological Engineering