CAR T Cells for Advanced Thyroid Cancer

项目摘要 据美国国家癌症研究所估计，2016年甲状腺癌的总发病率为64,300人。 经常表现为低分化甲状腺癌的患者对标准治疗无效。 而且预后要差得多。这一患者群体的总体生存中位数低于 一年。未分化或未分化的甲状腺癌通常不适合手术治疗，而且 对RAI和几乎所有其他疗法具有抵抗力。因此，我们开发了一种嵌合抗原受体(CAR)T 针对细胞间黏附分子-1(ICAM-1)(标记为AIC100)的细胞疗法治疗这种侵袭性疾病 甲状腺癌的类型。虽然体内的各种细胞通常表达低水平的基础ICAM-1，但许多 人类癌症已经上调了基因的表达水平。特别是，耐火材料分化差和 间变性甲状腺癌大大增加了ICAM-1的表达。我们汽车T细胞的关键方面 其技术是能够选择性地通过过度表达的ICAM-1杀死肿瘤，同时保留正常细胞 ICAM-1表达的基础水平。评估CAR T细胞在两种靶向肿瘤中的体内分布 作为非靶组织，我们引入了生长抑素受体2(SSTR2)来跟随CAR T细胞一段时间 使用临床批准的放射性标记示踪剂68Galium-DOTATATE(NetSpot)。在计划的第一阶段研究中， 主要目标是评估AIC100的安全性并确定第二阶段的推荐剂量。 复发/难治性低分化甲状腺癌和间变性甲状腺癌的研究 甲状腺癌。次要目标是评估AIC100在使用PET/CT和 RECIST(实体肿瘤反应评估标准)标准，评估CAR T细胞成像的可行性 通过DOTATATE，确定总体肿瘤反应是否与肿瘤部位T细胞分布相关，如 用DOTATATE和其他探索性生物标志物测定，并检查输液前T 作为临床反应预测因子的特征。我们的研究新药(IND)申请进入开放阶段 I AIC100治疗晚期甲状腺癌的研究现已于2019年10月获得FDA批准，患者 招生工作将于2020年初开始。由于CAR T的制造成本和临床护理的非标准 费用将由我们的行业合作伙伴(AffyImmune Treateutics，Inc.)赞助，主要目标是 授权应用是通过PET/CT来评估T细胞分布的动力学，并确定T细胞的出现 关于临床反应的高克隆性T细胞和相关的细胞和基因表达特征， 毒性和存活率；将固有的CAR T生存适合性和克隆扩增与临床联系起来 回应；优化T细胞制造和下一代汽车设计，以提高T车的适合性 细胞走向更有效的抗实体癌症的CAR T疗法。

Project Summary The overall incidence of thyroid cancer in 2016 was estimated by the National Cancer Institute to be 64,300. Patients who present with poorly differentiated thyroid cancers frequently are refractory to standard treatment regimens and have a much worse prognosis. The median overall survival in this patient population is less than a year. Undifferentiated or anaplastic thyroid cancers are typically not amenable to surgery and are highly resistant to RAI and virtually all other therapies. We therefore developed a chimeric antigen receptor (CAR) T cell therapy targeting intercellular adhesion molecule-1 (ICAM-1) (labeled as AIC100) to treat this aggressive type of thyroid cancer. While a variety of cells in the body normally express low, basal levels of ICAM-1, many human cancers have upregulated levels of expression. In particular, both refractory poorly differentiated and anaplastic thyroid cancers have greatly increased expression of ICAM-1. The key aspect of our CAR T cell technology is its ability to selectively kill tumors with over-expressed ICAM-1 while sparing normal cells with basal levels of ICAM-1 expression. To assess in vivo distribution of CAR T cells in both targeted tumors as well as non-target tissues, we have introduced the somatostatin receptor 2 (SSTR2) to follow CAR T cells over time using the clinically approved radiolabeled tracer 68Galium-DOTATATE (Netspot). In the planned phase I study, the primary objective is to assess the safety and determine the recommended dose of AIC100 for phase II study in patients with relapsed/refractory poorly differentiated thyroid cancer and in patients with anaplastic thyroid cancer. The secondary aims are to evaluate the efficacy of AIC100 in patients using PET/CT and RECIST (Response Evaluation Criteria In Solid Tumors) criteria, evaluate the feasibility of CAR T cell imaging by DOTATATE, determine if overall tumor response correlates with T cell distribution in tumor sites as measured by DOTATATE and other exploratory biomarkers, and to examine pre-infusion CAR T characteristics as a predictor of clinical response. Our investigational new drug (IND) application to open phase I study of AIC100 against advanced thyroid cancers is now approved by FDA in October 2019, and patient enrollment will commence in early 2020. As the cost for CAR T manufacturing and non-standard of care clinical costs will be sponsored by our industry collaborator (AffyImmune Therapeutics, Inc.), the major goals of this grant application are to assess the kinetics of T cell distribution by PET/CT, and determine the emergence of high clonality T cells and associated cellular and gene expression signatures with respect to clinical response, toxicity, and survival; to correlate intrinsic CAR T fitness for survival and clonal expansion with clinical response; to optimize T cell manufacturing and next-generation CAR designs to improve the fitness of CAR T cells toward more effective CAR T therapies against solid cancers.