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Published June 12, 2024 | in press
Journal Article Open

PSCA-CAR T cell therapy in metastatic castration-resistant prostate cancer: a phase 1 trial

Creators
Dorff, Tanya B. ORCID icon
Blanchard, M. Suzette
Adkins, Lauren N.
Luebbert, Laura ORCID icon
Leggett, Neena ORCID icon
Shishido, Stephanie N. ORCID icon
Macias, Alan
Del Real, Marissa M.
Dhapola, Gaurav
Egelston, Colt ORCID icon
Murad, John P. ORCID icon
Rosa, Reginaldo ORCID icon
Paul, Jinny ORCID icon
Chaudhry, Ammar ORCID icon
Martirosyan, Hripsime
Gerdts, Ethan
Wagner, Jamie R. ORCID icon
Stiller, Tracey
Tilakawardane, Dileshni
Pal, Sumanta ORCID icon
Martinez, Catalina
Reiter, Robert E. ORCID icon
Budde, Lihua E. ORCID icon
D'Apuzzo, Massimo ORCID icon
Kuhn, Peter ORCID icon
Pachter, Lior1 ORCID icon
Forman, Stephen J. ORCID icon
Priceman, Saul J. ORCID icon
  • 1. ROR icon California Institute of Technology

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.

Extended Data Fig. 2 Serum cytokine analysis.

Extended Data Fig. 3 Serum cytokines and chemistry in UPN388.

Extended Data Fig. 4 Analysis of UPN388 bone metastasis biopsy.

Extended Data Fig. 5 T cell infiltration and PD-L1 expression in biopsies.

Extended Data Fig. 6 Flow cytometric analysis of peripheral blood CD8 + PD-1 + CAR and non-CAR T cells in UPN388, UPN375, and UPN394.

Extended Data Fig. 7 Single-cell analysis of CD3 + T cell subsets and TCRα/β repertoire diversity in the peripheral blood.

Extended Data Fig. 8 TCR repertoire diversity in peripheral blood T cells.

Extended Data Table 1 PSCA IHC scores
 
Extended Data Table 2 Treatment responses
 
Supplementary Figs. 1–4 and Tables 1–4
 
Source data for Figs. 2–4 and Extended Data Figs. 1–8
 

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

Identifiers Funding Caltech Custom Metadata
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 (BBE)
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Resource type
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Publisher
Nature Publishing Group
Published in
Nature Medicine, ISSN: 1078-8956.
Languages
English

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Created:
June 13, 2024
Modified:
June 13, 2024
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