Safety and clinical activity of gene-engineered T-cell therapy targeting HPV-16 E7 for epithelial cancers.

Abstract

101 Background: Genetically engineered T-cell therapy has shown remarkable clinical activity in hematologic malignancies. It is not known if this type of treatment can be applied effectively to epithelial cancers, which account for 80% to 90% of human malignancies. Methods: We conducted a phase I clinical trial with a 3 + 3 dose escalation in which patients with metastatic HPV-16+ epithelial cancers were treated with a one-time infusion of genetically engineered T cells expressing a T-cell receptor targeting an HLA-A*02:01-restricted epitope of HPV-16 E7 (E7 TCR-T cells). A lymphocyte-depleting conditioning regimen was administered before cell infusion, and high-dose systemic aldesleukin was administered after cell infusion. Results: Twelve patients, previously treated with a median of 4 (range, 3 to 7) anticancer agents, were treated. The cell dose was not limited by toxicity. Six patients demonstrated objective clinical responses, which included regression of bulky tumors and complete elimination of some tumors. Responses occurred in patients with vulvar, anal, head and neck, and cervical cancer. Four patients who previously received PD-1-based therapy responded. Response duration ranged from 3 to 9 months. Sustained, high-level engraftment of E7 TCR-T cells in peripheral blood was observed (median after approximately 6 weeks, 66% of total T cells, range 1% to 88%) and correlated with cell dose but not with clinical response. Infused T cell characteristics did not correlate strongly with response. Of the 4 resistant tumors that were studied, 3 demonstrated genetic defects in HLA-A*02:01 or B2M (necessary components of the target complex) and 1 demonstrated copy loss with decreased expression of antigen presentation and interferon response molecules (i.e. TAP1, TAP2, IFNGR1, IFNGR2). Of the 3 sensitive tumors studied, 0 showed genetic defects in these molecules. Conclusions: E7 TCR-T cells demonstrated safety and clinical activity in the treatment of highly refractory metastatic HPV-16+ cancers. Treatment resistance was linked to definitive genetic defects in the targeted peptide-HLA complex and to manifold defects in antigen processing and interferon response. Clinical trial information: NCT02858310.

Tumor Immunity and Immunotherapy for HPV-Related Cancers

“…Another phase I study from the NIH demonstrated a slightly better response rate with autologous TCR T cells engineered to target HPV16 E7 (response in 4/12 patients; ref. 103). The patients on the trial included five with cervical cancer, four with HNSCC, two with anal cancer, and one with vulvar cancer.…”

Emerging and Experimental Agents for Anal Cancer: What is New?

“…Likewise, preliminary results of the Phase I study with modified T-cells were recently presented to identify the HLA-A 02:01 HPV16 E7 epitope (E7 TCR T-cells) in patients with refractory HPV16-positive tumors. 32 In the cohort of 12 patients, there were 2 patients with previously treated advanced SCCA. Both patients experienced partial responses lasting 3 and 9 months.…”

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“…Perhaps more significant, efficacy to date in solid tumors is unimpressive and safety issues, either off- or on-target, continue to plague clinical programs ( Lu et al , 2017 ; Norberg et al , 2020 ; Parkhurst et al , 2011 ). We believe these problems are also solvable.…”